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Article
Publication date: 9 October 2017

Rocco Palumbo, Silvia Cosimato and Aurelio Tommasetti

Service ecosystems are gaining credence among management scholars. However, there is still little agreement about the distinguishing attributes of service ecosystems in…

Abstract

Purpose

Service ecosystems are gaining credence among management scholars. However, there is still little agreement about the distinguishing attributes of service ecosystems in both the public and the private sectors. The purpose of this paper is to focus on the health care service system, suggesting a “recipe” for the implementation of a sustainable and innovative health care service ecosystem.

Design/methodology/approach

A mixed methodology was used. First, a critical literature review was conducted to lay the conceptual foundations of this study. Then a theory about the institutional, organizational and managerial requisites for the implementation of a health care service ecosystem was developed.

Findings

The health care sector is appropriate for the core tenets of the service ecosystem perspective. Tailored interventions aimed at improving the functioning of the health care service ecosystem should be implemented at the micro, meso, macro and mega levels. Patient empowerment, patient-centered care and integrated care are the fundamental ingredients of the recipe for effective health care service ecosystems.

Practical implications

The ecosystem approach provides health policy makers with interesting insights to help shape the health care service system of the future. The paper also contributes to the innovation of managerial practices emphasizing the role of patient involvement in the design and delivery of health care.

Originality/value

This is one of the first attempts to systematize scientific knowledge about service ecosystems in the health care sector. An agenda for further research is suggested, in order to further advance the establishment of an effective and innovative health care service ecosystem.

Details

The TQM Journal, vol. 29 no. 6
Type: Research Article
ISSN: 1754-2731

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Article
Publication date: 18 January 2021

Agnė Gadeikienė, Asta Pundzienė and Aistė Dovalienė

The rise of telehealth is evident worldwide, especially now with the COVID-19 pandemic situation, and is providing extensive opportunities for health-care organisations to…

Abstract

Purpose

The rise of telehealth is evident worldwide, especially now with the COVID-19 pandemic situation, and is providing extensive opportunities for health-care organisations to create added value for different stakeholders. However, even in this extreme situation, the progress of telehealth is quite slow and insufficient. In this context, it is necessary to consider how the application of telehealth services allows co-creating additional value for different stakeholders. Consequently, the purpose of this paper is to explore telehealth services and the added value that they co-create for various stakeholders across publicly and privately oriented health-care ecosystems.

Design/methodology/approach

This paper adopted a qualitative research design based on an explorative and comparative approach to study the perceived added value that is co-created during telehealth encounters. The authors deployed a semi-structured interview research design. Interviews were carried out in two settings that have different health-care systems: Lithuania (publicly oriented health care) and the California Bay Area, USA, (privately oriented health care). The research covers telehealth services from the point of view of different stakeholders in the health-care ecosystem.

Findings

The paper emphasises that value-in-use is essential in the case of telehealth; however, value-in-exchange is relevant to describe the relationships between public and private insurers and health-care providers. The findings point out that despite the type of health-care system, telehealth added value-in-use was perceived quite similar in both research settings, and differences could be distinguished mainly at the sub-dimensional level. The added value-in-use for patients comprises economic, functional and emotional value; physicians potentially get functional added value-in-use. The authors also highlight that patients and physicians get relational functional and social value-in-use. The added value-in-use for health-care providers consists of economic (in both research settings) and functional value (in Lithuania). The research findings show that there is still an evident lack of health insurance companies ready to recognise telehealth as a valuable service and to reimburse similarly to in cases of in-person visits. Thus, the added value-in-exchange is hardly created and this impedes co-creation of the added value-in-use.

Originality/value

This paper contributes to the field mainly by transferring the business research applied concept of value co-creation into the social-purpose driven health-care industry. The findings are beneficial for the health-care management stream of the literature, which considers health care as a value-based industry. To the best of the authors’ knowledge, this is the first attempt to structure the perceived telehealth added value from the perspectives of different stakeholders and two different health-care ecosystems. This paper also gives a clearer understanding of the role of the value-in-exchange in such complex ecosystems as health care and gives reasons when it could be created in synergy with co-creation of the value-in-use. In this sense, the findings are beneficial from both marketing and innovation theoretical perspectives, as they give a special attention to value creation and co-creation phenomena analysis.

Details

International Journal of Organizational Analysis, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1934-8835

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Article
Publication date: 14 March 2016

Kaisa Koskela-Huotari and Stephen L Vargo

– The purpose of this paper is to examine the role of institutions and institutional complexity in the process through which resources-in-context get their “resourceness.”

Abstract

Purpose

The purpose of this paper is to examine the role of institutions and institutional complexity in the process through which resources-in-context get their “resourceness.”

Design/methodology/approach

To shed light on the process of potential resources gaining their “resourceness,” the authors draw from two streams of literature: the service ecosystems perspective and institutional theory.

Findings

The authors combine the process of resources “becoming” with the concept of institutions and conceptualize institutional arrangements, and the unique sets of practices, symbols and organizing principles they carry, as the sense-making frames of the “resourceness” of potential resources. In service ecosystems, numerous partially conflicting institutional arrangements co-exit and provide actors with alternative frames of sense-making and action, enabling the emergence of new instances of “resourceness”.

Research limitations/implications

The paper suggests that “resourceness” is inseparable from the complex institutional context in which it arises. This conceptualization reveals the need for more holistic, systemic and multidisciplinary perspectives on understanding the implications of the process of resources “becoming” on value co creation, innovation and market formation.

Practical implications

As the “resourceness” of potential resources arises due to the influence of institutions, managers need a more profound understanding of the complimentary and inhibiting institutional arrangements and the related practices, symbols and organizing principles that comprise the multidimensional context in which they operate.

Originality/value

This paper is one of the first to focus specifically on the process of resources “becoming,” using a systemic and institutional perspective to grasp the complexity of the phenomenon.

Details

Journal of Service Theory and Practice, vol. 26 no. 2
Type: Research Article
ISSN: 2055-6225

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Article
Publication date: 18 April 2017

Gabriela Beirão, Lia Patrício and Raymond P. Fisk

The purpose of this paper is to understand value cocreation in service ecosystems from a multilevel perspective, uncovering value cocreation factors and outcomes at the…

Abstract

Purpose

The purpose of this paper is to understand value cocreation in service ecosystems from a multilevel perspective, uncovering value cocreation factors and outcomes at the micro, meso, and macro levels.

Design/methodology/approach

A Grounded Theory approach based on semi-structured interviews is adopted. The sample design was defined to enable the ecosystem analysis at its different levels. At the macro level was the Portuguese Health Information ecosystem. Embedded meso level units of analysis comprised eight health care organizations. A total of 48 interviews with citizens and health care practitioners were conducted at the micro level.

Findings

Study results enable a detailed understanding of the nature and dynamics of value cocreation in service ecosystems from a multilevel perspective. First, value cocreation factors are identified (resource access, resource sharing, resource recombination, resource monitoring, and governance/institutions generation). These factors enable actors to integrate resources in multiple dynamic interactions to cocreate value outcomes, which involve both population well-being and ecosystem viability. Study results show that these value cocreation factors and outcomes differ across levels, but they are also embedded and interdependent.

Practical implications

The findings have important implications for organizations that are ecosystem actors (like the Portuguese Ministry of Health) for understanding synergies among value cocreation factors and outcomes at the different levels. This provides orientations to better integrate different actor roles, technology, and information while facilitating ecosystem coordination and co-evolution.

Originality/value

This study responds to the need for a multilevel understanding of value cocreation in service ecosystems. It also illuminates how keystone players in the ecosystem should manage their value propositions to promote resource integration for each actor, fostering resource density and ecosystem viability. It also bridges the high-level conceptual perspective of Service-Dominant logic with specific empirical findings in the very important context of health care.

Details

Journal of Service Management, vol. 28 no. 2
Type: Research Article
ISSN: 1757-5818

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Article
Publication date: 28 March 2020

Genevieve Elizabeth O’Connor and Laurel Aynne Cook

The purpose of this paper is to address a critical problem for health-care organizations: patient referral leakage. This paper explores the nature of patient referrals by…

Abstract

Purpose

The purpose of this paper is to address a critical problem for health-care organizations: patient referral leakage. This paper explores the nature of patient referrals by examining how health-care providers’ breadth and depth of connectivity within a hospital network and identification with each other influence the likelihood of future patient referrals.

Design/methodology/approach

The data was collected by using a multi-sourced data set from the health-care industry. The proposed model was tested by using logistic regression to determine the likelihood of a primary care physician’s (PCP) referral to a specialist within a hospital network.

Findings

A model linking provider connectivity to examine co-creation practices in the form of patient referrals is tested. Results indicate that patient referrals are multidimensional. A PCP’s likelihood to refer to a specialist within the hospital network is influenced by the breadth and depth of connectivity of each provider.

Research limitations/implications

This investigation extends service ecosystems to patients, health-care providers and hospital organizations, making it the first to explore how different degrees of connectivity (breadth of referral partners and depth of exchange) between and among health-care providers influence the likelihood of future patient referrals. Findings complement extant literature on service ecosystems by empirically showing that provider relationships are interdependent and rely on the mutual coordination of benefits within the entire health-care organization and network.

Practical implications

Managers and health-care professionals can use the framework to build and strengthen relational ties/alliances within a service organization. An ecosystems perspective reduces patient referral leakage through enhanced organizational performance, competitive advantage and continuity of care.

Originality/value

The authors offer a novel view of referral relationships using hard-to-access proprietary data. Moreover, this study responds to the need for transformative service research by offering service researchers and policymakers a means to enhance consumer well-being. The main contribution of this study is a framework to gain a better understanding of patient referral relationships between employees (i.e., health-care providers) in an organization, thereby affording an opportunity to bolster operational efficiencies, improve clinical outcomes and strengthen referral pathways. By viewing health-care networks through a service ecosystems perspective, contextual boundaries and the relative power of relationships are also identified. The novel use of rarely available hospital data in this setting helps explain how patient leakage compromises the health of the ecosystem and its members.

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Article
Publication date: 3 August 2012

Harri Laihonen

This paper aims to hypothesize that modern health systems are transforming towards what has been called a health ecosystem in complexity‐based health care literature. It…

Abstract

Purpose

This paper aims to hypothesize that modern health systems are transforming towards what has been called a health ecosystem in complexity‐based health care literature. It has been argued that complexity arises from the interconnectedness, which in this paper is equated with knowledge flows between actors. The paper seeks to discuss the possible implications of a health ecosystem approach to health system management.

Design/methodology/approach

The paper is conceptual in nature but the transition towards a health ecosystem is illustrated with an example of a regional health care system in Finland. The case description and related analysis presented are based on qualitative data gathered by interviewing leading office‐holders, by process modeling and by observing management group meetings.

Findings

Conceptually, a health ecosystem seems to have potential for the system‐level analysis of the health care system. The discussion concludes that management of knowledge flows should be a strategic management function for individual health organizations as well as for the wider health system.

Research limitations/implications

This study focuses on a Finnish health care system. The operations and structures of health care services and systems vary in different areas and countries.

Practical implications

The practical illustration of the health ecosystem provides a reminder that health care systems are dynamic and largely based on interaction between different actors. The approach provides new strategic insights for the development of health care systems by concentrating on interrelationships and knowledge flows.

Originality/value

The literature has suggested that the ecosystem metaphor offers useful insights for the development of health care systems. Nevertheless, this approach has not been thoroughly studied so far. This paper makes a contribution by presenting a practical illustration of the framework and in light of this discusses the possible implications for health care management.

Details

Journal of Health Organization and Management, vol. 26 no. 4
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 30 December 2020

James Aitken, Ann E. Esain and Sharon Williams

Managing complexity within care ecosystems is an increasing universal challenge. In health, this is emphasised by recent calls for greater care integration to achieve…

Abstract

Purpose

Managing complexity within care ecosystems is an increasing universal challenge. In health, this is emphasised by recent calls for greater care integration to achieve service improvement as levels of comorbidity and frailty grow within populations. This research takes a service-dominant logic (SDL) stance in examining the sources, types and nature of complexity within a care ecosystem in the UK.

Design/methodology/approach

This illustrative case research focuses on a community care ecosystem. A multi-method approach is used combining semi-structured interviews, descriptive statistics and secondary data. The results were independently assessed and validated by participants through a second interview phase.

Findings

The findings from this research provide empirical support for the six complexities discussed in the supply chain literature. Identifying these complexities proffers the opportunity of applying manufacturing-derived complexity management strategies in care ecosystems. The conceptual model for institutional complexity, derived from the illustrative case study, showed that care professionals face additional complexity challenges in operating care ecosystems.

Practical implications

The management of complexity in care ecosystems requires professionals to be considerate of institutional arrangements when addressing the consequences of increasing levels of complexity. This necessitates the development of a balanced approach between reducing complexity while absorbing institutional arrangements which minimise risk.

Originality/value

Drawing on the supply chain complexity literature, the paper has developed a framework which guides care professionals facing increasing levels of complexity within the context of their institutional arrangements. As such, this research furthers our understanding of supply chain complexity effects in care ecosystems and provides a platform for future research.

Details

Supply Chain Management: An International Journal, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1359-8546

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Article
Publication date: 1 January 2021

Roderick J. Brodie, Kumar Rakesh Ranjan, Martie-louise Verreynne, Yawei Jiang and Josephine Previte

The COVID-19 pandemic has created a crisis for healthcare systems worldwide. There have been significant challenges to managing public and private health care and related…

Abstract

Purpose

The COVID-19 pandemic has created a crisis for healthcare systems worldwide. There have been significant challenges to managing public and private health care and related services systems’ capacity to cope with testing, treatment and containment of the virus. Drawing on the foundational research by Frow et al. (2019), the paper explores how adopting a service ecosystem perspective provides insight into the complexity of healthcare systems during times of extreme stress and uncertainty.

Design/methodology/approach

A healthcare framework based on a review of the service ecosystem literature is developed, and the COVID-19 crisis in Australia provides an illustrative case.

Findings

The study demonstrates how the service ecosystem perspective provides new insight into the dynamics and multilayered nature of a healthcare system during a pandemic. Three propositions are developed that offer directions for future research and managerial applications.

Practical implications

The research provides an understanding of the relevance of managerial flexibility, innovation, learning and knowledge sharing, which offers opportunities leading to greater resilience in the healthcare system. In particular, the research addresses how service providers in the service ecosystem learn from this pandemic to inform future practices.

Originality/value

The service ecosystem perspective for health care offers fresh thinking and an understanding of how a shared worldview, institutional practices and supportive and disruptive factors influence the systems’ overall well-being during a crisis such as COVID-19.

Details

Journal of Service Theory and Practice, vol. 31 no. 2
Type: Research Article
ISSN: 2055-6225

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Article
Publication date: 18 September 2020

Constance Dumalanede, Kavita Hamza and Marielle Payaud

This study aims to highlight the processes that private organisations implement to improve access to health care services for low-income communities in Brazil.

Abstract

Purpose

This study aims to highlight the processes that private organisations implement to improve access to health care services for low-income communities in Brazil.

Design/methodology/approach

A qualitative research based on a comparative case study was conducted in São Paulo. A for-profit organisation and a not-for-profit one were compared to scrutinise how they adapt themselves to the social context they are embedded in; while improving their service accessibility.

Findings

Both kinds of organisations have succeeded to reach their goal of improving the access and reducing the time frame of health care services to low-income populations. Their initial business model (BM) makes them face their own challenges that they face with different strategies. It affects their way of communicating, their organisational culture, the patients’ expectations and their level of inclusiveness.

Research limitations/implications

The research is context-dependent because of the specific conditions of the health public system in Brazil. When shaping health care BMs, the national context must be taken into account and the service marketing components should be used to enhance patients’ value co-creation in the health care service delivery process.

Practical implications

The research gives insights to organisations that seek to adapt their BM to improve health-care access to low-income populations.

Social implications

Health-care access plays a key role in improving populations’ living conditions and reach one of the sustainable development goals of the United Nation.

Originality/value

Health care services access at the bottom of the pyramid remains under-studied. The paper brings value by comparing for-profit and non-profit organisations, which have the same social goal of improving health-care access to low-income populations while developing different practices to deal with their own challenges.

Details

Society and Business Review, vol. 15 no. 3
Type: Research Article
ISSN: 1746-5680

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Book part
Publication date: 12 August 2014

Susan Albers Mohrman and Abraham B. (Rami) Shani

The chapter redefines the focus of the changes required to create sustainable healthcare away from fixing healthcare organizations and toward reconfiguring the constituent…

Abstract

Purpose

The chapter redefines the focus of the changes required to create sustainable healthcare away from fixing healthcare organizations and toward reconfiguring the constituent elements of the healthcare ecosystem and redefining how they interrelate to yield value more sustainably.

Methodology/approach

Based on a review of recent literature on healthcare reform, we argue that unlike other sectors, healthcare organizations cannot change themselves without changing their connections to the rest of the healthcare ecosystem, including other healthcare organizations, patients, governments, research institutions, vendors, and the citizenry at large. This is because these are not only stakeholders but also integral parts of healthcare processes.

Practical implications

Interventions intended to create more sustainable healthcare must bring together knowledge and perspectives from across the ecosystem, and must converge different sources of information and analysis to generate novel ways of connecting across the ecosystem. Change within a healthcare system cannot achieve the magnitude of transformation needed to become sustainable.

Social implications

If the healthcare ecosystem evolves in the manner described in this chapter, the healthcare ecosystem will no longer center around particular institutions and doctors’ offices but rather be defined by flexible and variable interactions between co-acting elements of the ecosystem.

Originality/value of chapter

The chapter treats the context as the focus of change in order to change the healthcare system. It proposes three kinds of flows: knowledge, clinical, and resource that are already beginning to change and that will eventually result in fundamentally different approaches to healthcare.

Details

Reconfiguring the Ecosystem for Sustainable Healthcare
Type: Book
ISBN: 978-1-78441-035-3

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