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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.

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.

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.

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.

The purpose of this paper is to examine how limited care patients and comprehensive care patients differ in terms of consumers' behavior in the dentist selection process, in order to help healthcare providers and marketers better promote their practice depending on their patient type.

A survey of 1,150 dental school faculty private practice patients who recently chose their dentist was conducted and 221 responded. The respondents were divided to comprehensive care patients (n=120) and limited care patients (n=90) by self‐perceived need.

The comprehensive care patients were younger and more likely to be highly educated, have a healthcare related profession, and have private dental insurance (p<0.001). The comprehensive care patients were more likely to use information sources such as clinic website, the internet, and the insurance directory (p<0.05), while the limited care patients were more likely to use other dentists. Comprehensive care patients put more value on attributes such as, the dentist is in my insurance network and convenient physical location (p<0.05). In conclusion, comprehensive care patients and limited care patients differed significantly in characteristics and how and why they chose their dentist.

Healthcare marketers can use this study's findings to better promote their practice by selecting appropriate communication channels and focus on attributes that consumers value the most. It is important to apply different strategies to different consumer groups.

Workplace voice is well-established and encompasses behaviors such as prosocial voice, informal complaints, grievance filing, and whistleblowing, and it focuses on interactions between the employee and supervisor or the employee and the organizational collective. In contrast, our chapter focuses on employee prosocial advocacy voice (PAV), which the authors define as prosocial voice behaviors aimed at preventing harm or promoting constructive changes by advocating on behalf of others. In the context of a healthcare organization, low quality and unsafe patient care are salient and objectionable states in which voice can motivate actions on behalf of the patient to improve information exchanges, governance, and outreach activities for safer outcomes. The authors draw from the theory and research on responsibility to intersect with theories on information processing, accountability, and stakeholders that operate through voice between the employee-patient, employee-coworker, and employee-profession, respectively, to propose a model of PAV in patient-centered healthcare. The authors complete the model by suggesting intervening influences and barriers to PAV that may affect patient-centered outcomes.

This paper aims to explore how tensions and alignments between different actors’ needs in a transformative services network affect balanced centricity, which is an indicator of well-being. Balanced centricity describes a situation in which all network actors’ interests and needs are fulfilled simultaneously. In such cases, all actors are better off, which increases both individual actors’ and overall actor-network well-being.

The empirical study takes place in nursing homes in which in-bed baths represent co-created service encounters that affect the well-being of focal actors (i.e. patients), frontline service employees (i.e. nurses) and transformative service mediators (i.e. family members), who have potentially competing needs. Using a qualitative, phenomenological approach, the study inductively explores and deductively categorizes actors’ personal experiences to gain deep, holistic insights into the service network and its complex web of actor interdependencies.

The resulting conceptual model of balanced centricity identifies actors’ lower-order needs as different manifestations of the psychological needs for autonomy, competence and relatedness. If actors’ needs are aligned, their psychological needs can be satisfied, which facilitates balanced centricity. If actors exhibit competing needs though, balanced centricity is impeded.

This study establishes actors’ psychological needs as the origin of tensions/alignments in multi-actor networks that impede/contribute to balanced centricity. Transformative service providers should try to address all actors’ psychological needs when co-creating services to achieve network well-being.

This study adopts a novel, multi-actor perspective and thereby presents a conceptual model that contributes to the understanding of balanced centricity. Future research could test this model in other transformative service settings.

Hidden behind such frequently used phrases as “The system/policy requires …,” “The organization has decided…” is one simple fact. Systems/policies don't drop from the sky etched in stone tablets and organizations don't decide anything. People make decisions and design systems and write policies. Embracing this fact increases the likelihood that the provision of health care emanates from a “care dealership” in contrast to a “car dealership.” Ignoring this fact leads to less humane, less effective, and more costly health care. This chapter will challenge all of us concerned with caring for all of us – from Organizational Development (OD). Practitioners to CEOs to … to … all of us at some point in our lives – to step up to the need to transform our most basic paradigms. To remind ourselves that human beings give birth to, nurture, sustain, and care for that which we call an organization. In so doing, we will be able to begin to act from the premise that a health care organization is itself a living breathing human organism, a “Patient” in need of care. The quality of care we afford this “Patient” directly and inevitably impacts the quality of care we are afforded as patients. Acting from this premise will transform all of health care, all “care dealerships” … and potentially “car dealerships” as well. OD professionals, therefore, can propel us all to a fourth dimension of caring for all of us.

The purpose of the paper is to investigate ambiguous language use in health-care project plans in a manner that accounts for the wider, institutional, public health-care context.

The article deployed a case study approach and drew from Fairclough's critical discourse analysis (CDA) as well as a keyword analysis to investigate two time-sequenced versions of the same project planning document for a health-care project in Finland.

In the project plans investigated, the study identified patient as a keyword possessing various meanings within the public health-care context. By examining the discursive practices around the keyword patient, the study demonstrated their role in constituting the institutional context as well as the function of this context in constraining these practices.

By looking at the potential of the CDA to investigate discursive practices of the keyword in two sequential versions of a project plan within the broader context of public health care, the study adds to the scant existing literature on critically oriented health-care project communication studies.

The work environment is known to influence professional attitudes toward quality and safety. This study sought to measure these attitudes amongst health professionals working in New Zealand District Health Boards (DHBs), initially in 2012 and again in 2017.

Three questions were included in a national New Zealand health professional workforce survey conducted in 2012 and again in 2017. All registered health professionals employed with DHBs were invited to participate in an online survey. Areas of interest included teamwork amongst professionals; involvement of patients and families in efforts to improve patient care and ease of speaking up when a problem with patient care is perceived.

In 2012, 57% of respondents (58% in 2017) agreed health professionals worked as a team; 71% respondents (73% in 2017) agreed health professionals involved patients and families in efforts to improve patient care and 69% (65% in 2017) agreed it was easy to speak up in their clinical area, with none of these changes being statistically significant. There were some response differences by respondent characteristics.

With no change over time, there is a demand for improvement. Also for leadership in policy, management and amongst health professionals if goals of improving quality and safety are to be delivered upon.

This study provides a simple three-question method of probing perceptions of quality and safety and an important set of insights into progress in New Zealand DHBs.

The purpose of this study is to explore the direct and indirect effects of perceived provider professionalism and service recovery in enhancing patient satisfaction in a developing country.

This study used a survey method to investigate satisfaction among health-care consumers. This study used data collected from 210 health-care consumers to empirically test the hypotheses via structural equation modeling

This study found that service recovery has a significant direct effect on patient satisfaction. Though this study did not find perceived provider professionalism to have a direct effect on patient satisfaction, it found an indirect effect in the relationship via service experience. Thus, service experience fully/completely mediates the relationship between perceived provider professionalism and patient satisfaction, while partially mediating the significant relationship between service recovery and patient satisfaction.

The results further underscore the need for health-care organizations in developing countries to focus on mindfully developing operations-oriented strategies that lead to the delivery of memorable service experiences for patients.

The purpose of the paper is to describe and analyze differences in patients' quality perceptions of private and public primary care centers in Sweden.

The article explores the differences in quality perceptions between patients of public and private primary care centers based on data from a large patient survey in Sweden. The survey covers seven dimensions, and in this paper the measure Overall impression was used for the comparison. With more than 80,000 valid responses, the survey covers all primary care centers in Sweden which allowed for a detailed analysis of differences in quality perceptions among patients from the different categories of owners.

The article contributes with a detailed description of different types of private owners: not-for-profit and for profit, as well as corporate groups and independent care centers. The results show a higher quality perception for independent centers compared to both public and corporate groups.

The small number of not-for-profit centers (21 out of 1,117 centers) does not allow for clear conclusions for this group. The results, however, indicate an even higher patient quality perception for not-for-profit centers. The study focus on describing differences in quality perceptions between the owner categories. Future research can contribute with explanations to why independent care centers receive higher patient satisfaction.

The results from the study have policy implications both in a Swedish as well as international perspective. The differentiation between different types of private owners made in this paper opens up for interesting discussions on privatization of healthcare and how it affects patient satisfaction.

The main contribution of the paper is the detailed comparison of different categories of private owners and the public owners.

The purpose of this paper is to explain how different emergency services adopt and adapt the same hospital-wide lean-inspired intervention and how this is reflected in hospital process performance data.

A multiple case study based on a realistic evaluation approach to identify mechanisms for how lean impacts process performance and services’ capability to learn and continually improve. Four years of process performance data were collected from seven emergency services at a Swedish University Hospital: ear, nose and throat (ENT) (two), pediatrics (two), gynecology, internal medicine, and surgery. Performance patterns were linked with qualitative data collected through realist interviews.

The complexity of the care process influenced how improvement in access to care was achieved. For less complex care processes (ENT and gynecology), large and sustained improvement was mainly the result of a better match between capacity and demand. For medicine, surgery, and pediatrics, which exhibit greater care process complexity, sustainable, or continual improvement were constrained because the changes implemented were insufficient in addressing the higher degree of complexity.

The variation in process performance and sustainability of results indicate that lean efforts should be carefully adapted to the complexity of the care process and to the educational commitment of healthcare organizations. Ultimately, the ability to adapt lean to a particular context of application depends on the development of routines that effectively support learning from daily practices.