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The purpose of this paper is to investigate the significance of value co-creation to the UK animal healthcare sector from the perspective of the key industry stakeholders: clients, veterinarians and paraprofessionals.

Value co-creation constructs in the sector were identified and measured using a mixed methods approach comprised of qualitative NVivo© thematic analysis of depth interviews (n=13) and quantitative exploratory factor analysis (EFA) (n=271).

Qualitative results revealed nine underlying dimensions regarding service delivery in the sector: trustworthiness, communication, value for money, empathy, bespoke, integrated care, tangibles, accessibility and outcome driven service. EFA of professional survey data loaded onto seven latent factors, with strong value co-creation dimensions identified.

The sampling process is sufficiently representative and diverse to present meaningful and valuable results, however, surveying should be extended to include the client group. Due to the originality of the research replication of the study will be beneficial to the broader understanding and application of value co-creation to the high-involvement services of animal healthcare.

Recognition of the importance of value co-creation to the sector should encourage professional stakeholders to develop and adopt integrated models of service provision and to provide improved levels of service quality.

The paper makes an original contribution to knowledge regarding value co-creation in respect of high-involvement service provision. Its findings should be of value to academics interested in value co-creation in service sectors as well as animal healthcare practitioners seeking to offer better value and quality service provision.

Antibiotic resistance (AR) is a global health crisis that is attracting focussed attention from healthcare, public health, governmental agencies, the public, and food producers. The purpose of this paper is to describe the work in Washington State to combat resistance and promote antimicrobial stewardship from a one health perspective.

In 2014, the Washington State Department of Health convened a One Health Steering Committee and two workgroups to focus on AR, the One Health Antimicrobial Stewardship work group and the One Health Antimicrobial Resistance Surveillance work group. The group organized educational sessions to establish a basic understanding of epidemiological factors that contribute to resistance, including antibiotic use, transmission of resistant bacteria, and environmental contamination with resistant bacteria and antibiotic residues.

The authors describe the varied uses of antibiotics; efforts to promote stewardship in human, and animal health, including examples from the USA and Europe; economic factors that promote use of antibiotics in animal agriculture; and efforts, products and next steps of the workgroups.

In Washington, human, animal and environmental health experts are working collaboratively to address resistance from a one health perspective. The authors are establishing a multi-species resistance database that will allow tracking resistance trends in the region. Gaps include measurement of antibiotic use in humans and animals; integrated resistance surveillance information; and funding for AR and animal health research.

Antimicrobial resistance (AMR) is a huge global challenge calling for changes in learning and working in health-care settings. The purpose of this study is to examine tensions expressed by professionals involved in AMR in three low- and middle-income countries (LMIC) in Asia and Africa.

The qualitative study was based on 60 face-to-face or online interviews in three LMICs. The interviews were analyzed by thematic analysis and analysis of elements of an activity system.

A number of tensions within activity systems were analyzed revealing key issues inhibiting reconceptualization of object of work and moving toward new activity. The study suggests four opposing forces: (1) cost efficiency and good public health objectives; (2) historically and culturally developed hierarchies and good public health objectives; (3) individual responsibility and institutional responsibility; and (4) fragmented set ups and holistic view of activity as critical when developing learning and work activities in analyzed settings.

This study expands the analysis of learning needs beyond individual skills and knowledge by taking a systemic approach using the cultural-historical activity theory framework. It shows that learning around AMR is needed at individual, organizational and national level.

The devastating 2014 Ebola outbreak caused human and economic loss, but it also resulted in remarkable improvement in healthcare leadership. The impact is most evident in the affected West African countries of Guinea, Liberia and Sierra Leone. In this chapter, the Ebola experience is used as a framework to explore the essential elements of healthcare leadership, with particular attention to healthcare crises in under-resourced communities. Overall, healthcare leadership presents unique challenges. In common with leaders of other industries, healthcare leaders must inspire others, create a sense of purpose, make difficult decisions and collaborate with a range of people. But, because their focus is on complex systems that aim to improve people's physical and mental well-being, expectations of healthcare leaders are especially high. Their work can be a matter of life or death. For the leader in an under-resourced area, the challenge and expectations are even higher, particularly in the face of new or emerging health threats. The key to effective healthcare leadership is systems thinking which involves looking at the entire system of care as an integrated whole, rather than discrete parts that operate in isolation. Healthcare leaders must understand that health means mobilizing multisectoral knowledge and resources and applying innovative and multiactor approaches to prevent, detect and address health problems. Since the 2014 Ebola crisis, healthcare leaders are increasingly using a systems approach by looking at the culture of health systems, the impact of diseases locally and globally, and the applicability of health interventions in different environments. In the post-Ebola era, steps to strengthen the healthcare system are described which includes the roles of healthcare leaders. These steps include deployment of field epidemiologists and community health agents, community education and fuller use of the One Health Platform, which allows actors from different sectors (human health, animal health and environmental health) to collaborate. Finally, suggestions for healthcare leadership training are offered.

The purpose of this paper is to examine the governance and policy-making challenges in the context of “wicked problems” based on the case of pandemic influenza.

The case study research is based on an analysis of official documentation and interviews with policy elites at multiple levels of UK governance.

Results of this study show that policy actors regard risk communication, the dynamics of international public policy and UK territorial governance as the main governance challenges in the management of influenza at a macro-level. The paper also serves to identify that although contingencies management for epidemiological issues require technical and scientific considerations to feature in governance arrangements, equally there are key “wicked problems” in the context public policy that pervade the health security sector.

The study indicates the need to build in resources at a national level to plan for policy coordination challenges in areas that might at first be seen as devoid of political machinations (such as technical areas of public policy that might be underpinned by epidemiological processes). The identification of the major governance challenges that emerge from the pandemic influenza case study is a springboard for a research agenda in relation to the analysis of the parallels and paradoxes of governance challenges for health security across EU member states.

This paper provides a novel interrogation of the pandemic influenza case study in the context of UK governance and public policy by providing a strategic policy lens from perspective of elites.

Celebrex became the first of a new class of drugs known as COX‐2 selective non‐steroidal anti‐inflammatory drugs. It improves treatment for arthritis sufferers without compromising the protective lining of the stomach. The purpose of this paper is to illustrate how direct‐to‐consumer advertising (DTCA) of prescription medicines can be used to rebuild faith in the cyclooxygenase‐2 (COX‐2) product category.

The case is developed using published sources and no input is required from company representatives. The presentation style follows the classic comprehensive case format used in postgraduate teaching programmes.

Business executives and strategic marketing students would benefit from a discussion on how external environmental factors can suddenly impose a review of marketing strategy. The reader learns how management addresses the business dilemma using DTCA.

A blockbuster rival drug Vioxx is withdrawn due to cardiovascular (CV) health safety concerns. A resulting dominant market situation soon becomes a business dilemma. The Federal Drug Administration calls for a “black box” warning label on Celebrex, the most serious type of warning.

The implications are that having a product in a class of its own is not enough. It highlights the need to communicate to different audiences, to both the medical profession and the end‐user. Getting doctors to recommend the medicine and pulling the product through the channel by stimulating patient demand after a health scare are paramount.

This is the first pharmaceutical business case where the withdrawal of a rival product leaves the dominant competitor in a monopoly situation. Contrary to expectation, market share plummets despite the absence of competition.

Agriculture and associated services are central to the rural economy of the United Kingdom. Rural veterinary enterprises are important providers of services to livestock producers, but are now facing concerns over their future economic viability. The objectives of this chapter are to outline the changes occurring in the veterinary and agricultural sectors, and to explore the main issues affecting veterinary enterprises in a changing business environment.

This is a conceptual chapter contextualised mainly within the United Kingdom. As such, the methodological approach comprises a critical review of current academic literatures, as well as government reports and relevant media articles.

The findings demonstrate that the commercial success of rural veterinary enterprises is critical to ensuring the future provision of high-quality animal health services to both farmers and government. The current issues facing farmers are likely to affect their willingness and resources to invest in veterinary services. Furthermore, farmers may have doubts as to vets’ ability to provide business-focussed services that add value. In addition, many public services are outsourced to private veterinary enterprises, and forthcoming policy changes are expected to lead to reduced income from public sources for both vets and their livestock farming clients. While wider issues affecting agriculture are beyond the control of private veterinary practitioners, veterinary enterprises will need to ensure that they can deal with such challenges and, where required, adapt their services accordingly.

The chapter is based on a review of extant literatures, and the scope of the research is therefore limited to existing knowledge about the farm animal veterinary business landscape.

The chapter summarises current knowledge of the challenges facing rural veterinary enterprises. While some of the issues described are specific to the veterinary sector, many are also relevant to other rural SMEs providing knowledge-intensive services to farmers. The chapter also describes areas requiring further empirical research.