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Policymakers push online health services delivery, relying on consumers to independently engage with online services. Yet, a growing cluster of vulnerable patients do not engage with or disengage from these innovative services. There is a need to understand how to resolve the tension between the push of online health service provision and unengagement by a contingent of health-care consumers. Thus, this study aims to explore the issue of digital unengagement (DU) (i.e. the active or passive choice to engage or disengage) with online health services to better inform service design aligned to actual consumer need.

Adopting a survey methodology, a group of 486 health services consumers with a self-declared (acute or chronic) condition were identified. Of this group, 110 consumers were classified as digitally unengaged and invited to write open-ended narratives about their unengagement with online health services. As a robustness check, these drivers were contrasted with the drivers identified by a group of digitally engaged consumers with a self-declared condition (n = 376).

DU is conceptualized, and four levels of DU drivers are identified. These levels represent families of interrelated drivers that in combination shape DU: subjective incompatibility (misalignment of online services with need, lifestyle and alternative services); enactment vulnerability (personal vulnerabilities around control, comprehension and emotional management of online services); sharing essentiality (centrality of face-to-face co-creation opportunities plus conflicting social dependencies); and strategic scepticism (scepticism of the strategic value of online services). Identified challenges at each level are the mechanisms through which drivers impact on DU. These DU drivers are distinct from those of the digitally engaged group.

Adding to a nascent but growing literature on consumer unengagement, and complementing the engagement literature, the authors conceptualize DU, positioning it as distinct from, not simply a lack of, consumer engagement. The authors explore the drivers of DU to provide insight into how DU occurs. Encapsulating the dynamic nature of DU, these drivers map the building blocks that could help to address the issue of aligning the push of online service provision with the pull from consumers.

This paper offers insights on how to encourage consumers to engage with online health services by uncovering the drivers of DU that, typically, are hidden from service designers and providers impacting provision and uptake.

There is a concern that there will be an unintentional disenfranchisement of vulnerable segments of society with a generic policy emphasis on pushing online services. The paper sheds light on the unforeseen personal and social issues that lead to disenfranchisement by giving voice to digitally unengaged consumers with online health services.

Offering a novel view from a hard-to-reach digitally unengaged group, the conceptualization of DU, identified drivers and challenges inform policymakers and practitioners on how to facilitate online health service (re)engagement and prevent marginalization of segments of society.

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.

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.

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.

The organization of the corporate marketing function has attracted increasing attention from marketers in the 1990s. This reflects both the significant conceptual developments in marketing theory and a questioning of the role of the centralized marketing department to organizations operating in post‐industrial service economies. Drawing on data from a broader research project into marketing activity in the acute health care sector in the United Kingdom, the paper examines the organizational solutions adopted by self‐governing hospitals in managing the marketing function. The core theme to emerge from the research is the imperative for such professional service organizations to facilitate the development of flexible, project focused marketing teams, effectively mirroring the notion of the buying centre, capable of integrating core technical professionals directly into the marketing process. Coupled to this is the notion of marketing professionals having to abdicate ownership, and even dominance, of the corporate marketing process.

The internet driven information revolution is frequently cited as one of the key drivers (re‐)shaping contemporary consumption. In particular, the internet has been seen as disrupting established conventions in professional services. Popularly, it has been viewed as a liberating medium, a mechanism by which consumers and citizens have been able to challenge the authority of the professional establishment. Yet for consumers, the internet can equally be viewed as generating new uncertainties and challenges in terms of negotiating a new settlement with professionals and reconfiguring the service encounter. The purpose of this paper is to explore experiences of consumers with the use of internet derived information in respect of complex professional services and the impact of such information utilisation on the format of the service encounter.

Empirical data is generated through interviews with professionals (n=24) and consumer focus groups (n=10/53).

The paper argues that the multi‐faceted nature of the internet creates informational “spaces” which present both opportunities and threats to consumers in renegotiating the service encounter. Balancing the paradoxes created by these informational spaces is at the core of the challenge confronting contemporary service consumers. Irrespective of the nature of that space, the effect is to create a driver for change, challenging the established practices of both consumer and professional to reshape the service encounter.

Focus group research does not enable a judgement about the prevalence or distribution of behaviours among consumers. Nevertheless, this paper advances understanding of contemporary consumption practices and provides a new perspective on nature of consumer utilisation of information within the consumption process.

It is inevitable that professionals and service organisations will be required to respond to a complex and rapidly evolving set of consumer behaviours and rethink approaches to the delivery of professional services.

The paper addresses an emergent phenomenon and provides unique insights into the changing dynamics of consumption practices in the contemporary knowledge economy.

This paper considers the notion of consumer empowerment across the financial, legal and medical service sectors in the UK. Although the advent of the internet is generally seen as potentially enabling consumer empowerment, theoretical papers divide on the question of efficacy. On the one hand, it is argued the much‐vaunted internet opportunity must not be simply taken as evidence of change in the consumer‐producer relationship. On the other the change must not be unquestioningly be taken as advantageous to the consumer.

Empirical data were generated through ten consumer focus groups and eight interviews with professionals.

The paper supports the contention that empowerment is partial and unevenly distributed among consumers. It is argued that characterisations of consumer indifference and producer discipline as preventing effective empowerment are too simplistic. Additionally, any taboo restraining the questioning of professional judgement is largely absent from the assumption of choice and of recognition/respect among the consumers participating in the research.

Focus group research does not enable a judgement about the prevalence or distribution of empowerment assumptions among consumers.

It is inevitable that in the broader consumer market professionals will be required to respond to a complex of consumer assumptions and these will include an assumption of empowerment.

Much of the services research in marketing has been set within the service recovery paradigm; given information, consumer power is an implied function of the market. In this paper, we see consumer empowerment as a process of negotiation partially facilitated by information.

Research into inter‐organisational relationships has been one of the key drivers in the development of services marketing theory. Yet the understanding of the nature of such relationships, and the management of the relationship process, remains limited. Focusing on the development of buyer‐seller relationships in an archetypal professional business service, this paper aims to critically examine the nature and format of inter‐organisational service relationships.

Research reported in the paper is based on case study research across multiple dyads (n=7) in the occupational health sector supported by large‐scale survey data.

Argues that, rather than adhering to a single format in terms of characteristics or pattern of development, relationships are diverse and complex. A typology of “ideal type” relationship formats, ranging from quasi‐transactional to internalised, is proposed. Each of these ideal types is characterised by a unique set of causal and resultant conditions.

The paper is based on data from a single, albeit archetypal, professional business service. Consequently future research should address the replicability of the results across other service sectors.

The identification of these discrete relationship formats and their key characteristics along a continuum provides an empirical basis on which service professionals can develop targeted strategies for the management of particular inter‐organisational relationships.

Building on preceding research, the paper provides empirically based analysis of the nature and format of inter‐organisational relationships in professional service markets.

Driven by technological developments, deregulation, and globalisation the service sector in post‐industrial economies is facing unprecedented change. Utilising a scenario planning framework, the paper examines the impact of such changes on a cross‐section of service categories. Acknowledging that the derivation of generic sector wide trends from the analysis of discrete service categories runs the risk of over simplification, three core trends were identified: the increasing importance of technological mediation; changing consumer and professional roles; and decreasing importance of relational factors in consumer decision making. These trends pose fundamental challenges to service providers and offer researchers a rich context in which to advance marketing theory.

This paper considers the impact of the Internet on professional services, which are characterised by high levels of interpersonal interaction and where a significant component of the service product is information and expertise. For such services the Internet is primarily an accessible information resource, which has potential to fundamentally change the way in which consumers interact with service providers. The context for the research is healthcare, a professional service that has traditionally been characterised by an information asymmetry that has rested power in the hands of the professional. Based on interviews with healthcare professionals, Web site hosts and consumers, this paper considers the way in which consumers use the Internet to educate themselves about their condition and the consequent effect on the service encounter and the doctor/patient relationship. The findings indicate that patients are increasingly engaging in virtual, parallel service encounters that change the nature of the primary encounter and present challenges to professionals both in terms of relationships and their professional judgement.

The concept of the primary health‐care team involving an increasingly diverse range of health care professionals is widely recognized as central to the pursuit of a primary care‐led health service in the UK. Although GPs are formally recognized as the team leaders, there is little by way of policy prescription as to how team roles and relationships should be developed, or evidence as to how their roles have in fact evolved. Thus the notion of the primary health‐care team while commonly employed, is in reality lacking definition with the current contribution of practice managers to the operation of this team being poorly understood. Focusing on the career backgrounds of practice managers, their range of responsibilities, and their involvement in innovation in general practice, presents a preliminary account of a chief scientist office‐funded project examining the role being played by practice managers in primary health‐care innovation. More specifically, utilizing data gained from the ongoing study, contextualizes the role played by practice managers in the primary health‐care team. By exploring the business environment surrounding the NHS general practice, the research seeks to understand the evolving world of the practice manager. Drawing on questionnaire data, reinforced by qualitative data from the current interview phase, describes the role played by practice managers in differing practice contexts. This facilitates a discussion of a set of ideal type general practice organizational and managerial structures. Discusses the relationships and skills required by practice managers in each of these organizational types with reference to data gathered to date in the research.

Unlike managers in most service organizations, hospital managers do not have significant control over the shape or cost of the service product or the manner of its delivery. Hence, the crucial issue for hospital management to address is how to develop the marketing of a service the control of which is divorced from those with the strategic market perspective. While the internal management of hospital care in the NHS is in its infancy, initial developments such as clinical directorates point the way forward in creating a market orientation within provider units. Ultimately, it must be considered what degree of influence over clinical decisions affecting hospital services is realistic, ethical and desirable for strategic marketing and business services. Arguably there is a case for the adoption of some middle ground, with both sides moving from their present positions but perhaps with the clinicians moving furthest.