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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.

The quality of asthma care may be affected if asthma management is overlooked, thus needing frequent clinical audits to identify areas for improvement. The purpose of this paper is to evaluate the quality of the process (e.g. documentation of asthma-specific information), the structure (e.g. availability of resources) and the outcome (e.g. proportion of patients prescribed with asthma medications) at a university-based primary care clinic. The associated clinical factors for non-documentation of asthma control at the last visit were also examined.

This retrospective study involved auditing medical records and the pharmacy data system of 433 adult patients with asthma to evaluate 18 quality indicators. The standard target for the indicators of process and structure was 80 percent and the standard target for the indicators of outcome was 100 percent.

All the indicators failed to reach the standard targets. Documentation of asthma-specific information and availability of resources were deficient. The non-documentation of asthma control was significantly associated with presence of acute complaint(s) unrelated to asthma, presence of other issues and number of the documented parameters for asthma control. Although the prescription rates of inhaled reliever and preventer were substandard, they were reasonably high compared to the targets.

In this study, evaluation of the quality of care was limited by absence of asthma register, use of paper-based medical records and restricted practice capacity. Besides, the asthma-specific assessments and management were only audited at one particular time. Furthermore, the findings of this study could not be generalised to other settings that used other methods of record keeping such as patient-held cards and electronic medical records. Future studies should sample asthma patients from a register, evaluate more reliable quality indicators (e.g. over-prescription of short-acting β-2 agonist and underuse of inhaled corticosteroid) and assess asthma management over a duration of time.

This study provides quality information on all aspects of asthma care (process, structure and outcome) which can be a basis for clinical improvement. It is hoped that the study could assist the stakeholders to plan strategies for improvement of the asthma care. A more strategic and reliable system of documentation is needed, such as the use of a simple template or structured form, which should not jeopardise the provision of personalised and comprehensive care. With complete documentation, thorough investigational audits can be continuously performed to determine the quality of asthma care.

This study could provide useful findings to guide healthcare providers in developing a more strategic model of asthma care that can ensure asthma patients to receive a personalised, comprehensive, holistic and continuous care. Through this approach, their physical and psychosocial well-being can be optimised.

Even though our healthcare has advanced, the quality of asthma care is still suboptimal which requires further improvement. However, it could be considered assuring due to high outcome levels of asthma care despite having limited resources and practice capacity.

Guided by the growing importance of social-mediated organisational communication, this study examines how communication professionals within healthcare organisations perceive and respond to the reputation impacts of social media on the organisation’s reputation. Although the healthcare sector finds itself in the midst of a (continually) transforming landscape characterised by large amounts of digital health (mis)information and an empowered “patient-as-consumer”, little is known about how professionals in this sector understand the changes and respond to them. Moreover, much extant scholarship on the topic is published in specialised health or medical journals and does not explicitly address the communication implications for healthcare organisations.

In-depth semi-structured interviews were conducted with communication professionals responsible for social media across eight hospitals in the Netherlands. The sample included two participants working as communication consultants/social media advisors for healthcare organisations. In all, 15 interviews were conducted.

Building on interviewee perspectives, the authors advance the CARE (Control, Access(ability), Responsive(ness) and Engagement) model of social-mediated communication, highlighting the dualistic characteristics of each dimension. This model is built upon a careful analysis of healthcare professional responses. In an always-on environment, understanding and managing the tensions within the authors’ model may be decisive to the reputation implications of social media use.

Understanding the tensions within each dimension lends a more nuanced perspective on the potential impact(s) of social media as experienced by professionals in the field. In shifting away from a binary, either/or approach, the paper contributes to explicating the complexities of a pervasive phenomenon (i.e. social-mediated communication) and its multifaceted impacts on the healthcare sector.