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Co-­‐creation and learning in healthcare service development
Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.ORCID iD: 0000-0003-4040-8302
2012 (English)In: Journal of Service Management, ISSN 1757-5818, E-ISSN 1757-5826, Vol. 23, no 3, 328-343 p.Article in journal (Refereed) Published
Abstract [en]

Purpose - This study has the purpose of developing and evaluating a model for patient cocreation and learning based on diaries for use in healthcare service development. In particular, we investigate the process of patient co-creation and different mechanisms through which healthcare service providers can learn from the patient.

Design/methodology/approach – The study is based on an action research approach. First, a development phase for patient co-creation and learning leading to a proposed model was conducted. Second, a test phase of the diary-based method was performed on 53 patients in three cases: orthopaedic care, rehabilitation care and gastroenterology care.

Findings – We suggest a model for co-creation and learning in healthcare service development with three ways of learning. Firstly, the model may be used as a means for generating and collecting patient ideas; secondly, a single patient’s story can be illustrated, and serve as an incentive for healthcare service development and creation of patient-centred care; finally, a larger number of diaries can be analysed and combined with patient surveys to provide a deeper understanding of how the patient experiences health care services.

Originality/value – This study extends the research on diary-based methods as an operationalisation of co-creation in two ways. Firstly, the study offers new and more diverse ways of using the rich material provided by customer diaries in the development of services. Secondly, the study suggests a co-creation approach of involving patients in healthcare service development through patient diaries.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2012. Vol. 23, no 3, 328-343 p.
Keyword [en]
Co-creation, service development, healthcare, action research
National Category
Engineering and Technology
Identifiers
URN: urn:nbn:se:liu:diva-78716DOI: 10.1108/09564231211248435ISI: 000308627000003OAI: oai:DiVA.org:liu-78716DiVA: diva2:535094
Available from: 2012-06-19 Created: 2012-06-19 Last updated: 2017-12-07Bibliographically approved
In thesis
1. Co-creation in Healthcare Service Development: A Diary-based approach
Open this publication in new window or tab >>Co-creation in Healthcare Service Development: A Diary-based approach
2012 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

The patient is the only person who experiences the complete course of a healthcare problem, from first symptom to any contacts with the healthcare system to examination, treatment, follow-up activities and rehabilitation. The aim of this thesis is to explore how caregivers, together with patients, can draw on the knowledge patients acquire from their experiences in healthcare service development. This represents a break with the traditional role of the patient, which has been one of a passive receiver of care, following a supplier-centered view on value creation, which has increasingly been challenged both in the healthcare management discourse and in service research. Instead it is argued that value can only be co-created with customers, or patients in the case of healthcare. This means that the patients’ value-creating processes and contexts need to be emphasized and that patients are seen as a possible resource in their own care but also in the development of services and products. Despite this change in discourse, practical methods and empirical studies concerning patient involvement are scarce. This thesis adds to the field through an empirical exploration of co-creation in the development of healthcare. Through an action research approach, researchers and healthcare personnel have collaborated to develop a model for involving patients in service development, by inviting patients to share ideas and experiences through diaries.

A workable, three-phase (preparation, execution and learning) model for patient involvement through diaries has been developed, and applied in three clinics (orthopedic, rehabilitation, gastro). A total of 53 patients from the different care processes have contributed ideas and experiences using paper and pen diaries or blogs, or by calling an answering machine. By doing so for a period of 14 days, the patients have submitted a total of 360 ideas.

Three ways are proposed for utilizing the rich data submitted by the patients in service development. First, ideas from diaries can be used as input for service development. Second, a larger sample of diaries can be used to create a report of patient experiences, in which problem areas in the care process can be identified, and combined with other statistics. Third, individual patients’ stories can be highlighted and serve as a basis for discussion in the organization to shift the focus to the patient’s experience, serving as a motivator for change within the caregiving organization.

The study shows that patients can share ideas and experiences regarding a range of topics, including clinical, organizational, social, informational, and practical issues and attitudes among healthcare staff. The contexts to which these ideas and experiences applied were caregiver, home, extended caregiver, and work, and often concerned topics and aspects of the patient’s care process that are invisible to the caregiver.

Although healthcare organizations should be aware of the limitations to participation an illness may imply among some patients, patient co-creation in service development provides several important benefits. Acquiring knowledge regarding the parts of the patient’s care process that are invisible to the caregiver is key to improving care and supporting patients’ work of healing and managing life. Patients’ insights and creativity are an untapped resource for development of many aspects of the healthcare process.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2012. 54 p.
Series
Linköping Studies in Science and Technology. Thesis, ISSN 0280-7971 ; 1539
National Category
Engineering and Technology
Identifiers
urn:nbn:se:liu:diva-78717 (URN)LiU-TEK-LIC 2012:24 (Local ID)978-91-7519-864-4 (ISBN)LiU-TEK-LIC 2012:24 (Archive number)LiU-TEK-LIC 2012:24 (OAI)
Presentation
2012-06-12, ACAS, A-huset, Campus Valla, Linköpings universitet, Linköping, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2012-06-19 Created: 2012-06-19 Last updated: 2012-06-19Bibliographically approved
2. Patient involvement and service innovation in healthcare
Open this publication in new window or tab >>Patient involvement and service innovation in healthcare
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis adds to a stream of research suggesting that healthcare can be more patient centered and efficient by redefining the role of the patient from a passive receiver to a more active and collaborative participant. This may relate to healthcare provision (Anderson and Funnell, 2005; Berry and Bendapudi, 2007; Bitner and Brown, 2008; McColl-Kennedy et al., 2012; Nordgren, 2008) and innovation (Bate and Robert, 2006; Groene et al., 2009; Longtin et al., 2010). Through research initiative containing four healthcare units and 68 patients, the present thesis combines healthcare research (e.g., Anderson and Funnell, 2005; Nelson et al., 2002) with service research (e.g., Grönroos, 2006; Vargo and Lusch, 2008, 2004) to explore three aspects of patient involvement and service innovation.

Firstly, the concept of patient involvement itself is investigated through an extensive literature review of empirical research on patient involvement. A model describing the antecedents, forms and consequences of patient involvement is proposed. What value is, and how patients can co-create value is discussed from the perspectives of healthcare research and service management thought.

Secondly, the thesis proposes a diary-based methodology for involving patients in service innovation. My colleagues and I developed the methodology in collaboration with the participating care providers and applied it in practice. We used the experiences we gained from the project and the contributions from the patients to examine the opportunities for user involvement in service innovation. The participants contributed with ideas and insights stemming from their experiences in their contact with healthcare and other resources. We suggest the following three ways of learning from the collected data: As ideas for improvements; through summary reports to illustrate other quantitative data; and as narratives to promote change.

Thirdly, the thesis explores patients’ motivations to participate in service innovation, a hitherto unexplored field. Through an analysis of patients’ contributions and interviews with participants we found that there are a number of factors that motivate patients to participate and that participation is perceived as a social- and meaningladen event. Patients derive psychological well-being and support from participation, but disease was sometimes a barrier to participation. This thesis elaborates on how the most motivated users can be involved in service innovation, applying thinking from the lead-user methodology to a healthcare setting.

Overall, the thesis explores patient involvement from new perspectives and, by doing so, adds to our collective efforts to improve healthcare.

Abstract [sv]

Denna avhandling syftar till en mer patientcentrerad och effektiv sjukvård. Den bidrar till en strömning inom forskningen som menar att sjukvården kan förbättras genom en omdefiniering av patientrollen – från en roll som passiv mottagare till aktiv, samskapande aktör. Patienten kan ses som en resurs både i utförande av vården (Anderson and Funnell, 2005; Berry and Bendapudi, 2007; Bitner and Brown, 2008; McColl-Kennedy et al., 2012; Nordgren, 2008) och inom utveckling och innovation (Bate and Robert, 2006; Groene et al., 2009; Longtin et al., 2010). Avhandlingen kombinerar sjukvårdsforskning (Anderson and Funnell, 2005; Nelson et al., 2002) med tjänsteforskning (Grönroos, 2006; Vargo and Lusch, 2008, 2004) i en forskningsansats som innefattar fyra vårdenheter och 68 patienter. Den utforskar tre aspekter av patientinvolvering och tjänsteinnovation.

För det första undersöks konceptet patientinvolvering genom en omfattande litteraturöversikt av den empiriska forskningen på området. Översikten leder till en konceptuell modell för att beskriva patientinvolvering: vad dess förutsättningar är, vilka former av patientinvolvering som finns och vad patientinvolvering leder till. Avhandlingen diskuterar även begreppet värde och hur patienter kan samskapa värde, utifrån perspektiv inom vårdforskning och tjänsteforskning.

För det andra föreslår avhandlingen en dagboksbaserad metod för att involvera patienter i tjänsteinnovation. Deltagande patienter skriver i denna metod ner sina ner sina idéer och upplevelser varje dag under två veckors tid. Mina kollegor och jag utvecklade metoden i samarbete med personal från de deltagande vårdenheterna och applicerade den på praktiken. Erfarenheterna från projektet och de deltagande patienternas bidrag användes för att utforska möjligheterna med patientinvolvering i utvecklingen av vården. Vi föreslår tre sätt att lära sig från det insamlade materialet: som direkta idéer till förbättringar; summerat till rapporter för att ge kvalitativ förståelse av andra kvantitativa mätningar; och enskilda patienters berättelser kan användas för att förmedla patientperspektivet i organisationen och mana till förändring.

För det tredje undersöker avhandlingen patienters motivation att bidra till tjänsteinnovation, ett hittills outforskat område. Genom en analys av patienters bidrag och genom intervjuer med deltagare finner vi att patienter motiveras att delta av en rad olika anledningar, från ett behov av upprättelse till en glädje av att utföra aktiviteten. Deltagandet uppfattas som en social och meningsfull händelse. Patienter upplever psykiskt välbefinnande och stöd genom att delta, även om sjukdom kan vara ett hinder i deltagandet. Avhandlingen undersöker även hur de allra mest motiverade patienterna kan identifieras och inkluderas i tjänsteinnovation, detta inspirerat av lead  user-metoden (von Hippel, 1986).

Sammantaget utforskar avhandlingen patientinvolvering och tjänsteinnovation från nya perspektiv och bidrar därmed till våra gemensamma ansträngningar för att förbättra vården och patienters välbefinnande.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2014. 91 p.
Series
Linköping Studies in Science and Technology. Dissertations, ISSN 0345-7524 ; 1604
Keyword
Patient Involvement, participation, co-creation, patient empowerment, user involvement. patient centered care, motivation, user experiences, co-creation, service development, service innovation, service design, health care, lead users, diary, value
National Category
Engineering and Technology
Identifiers
urn:nbn:se:liu:diva-106661 (URN)10.3384/diss.diva-106661 (DOI)978-91-7519-304-5 (ISBN)
Public defence
2014-05-28, A-cas, A-huset, Campus Valla, Linköpings universitet, Linköping, 13:15 (English)
Opponent
Supervisors
Available from: 2014-05-19 Created: 2014-05-19 Last updated: 2014-06-17Bibliographically approved

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Elg, MattiasEngström, JonWitell, LarsPoksinska, Bozena

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