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Patient involvement and service innovation in healthcare
Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
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 [en]
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: urn:nbn:se:liu:diva-106661DOI: 10.3384/diss.diva-106661ISBN: 978-91-7519-304-5 (print)OAI: oai:DiVA.org:liu-106661DiVA: diva2:717875
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
List of papers
1. The Antecedents and Consequences of Patient Involvement: A Systematic Review and Thematic Analysis
Open this publication in new window or tab >>The Antecedents and Consequences of Patient Involvement: A Systematic Review and Thematic Analysis
2013 (English)Conference paper, Oral presentation only (Other academic)
Abstract [en]

Background: A literature review was conducted to explore the concept of patient involvement and to integrate the findings of existing research.

Methods: A database search was conducted (in Pubmed, CINAHL, Academic Search Premier, EconLit and PsycINFO) for articles in the field of patient involvement in health care published between 1990 and 2012. Out of 3,402 references, 125 articles were eligible for this review. We analyzed our sample using thematic analysis.

Results: Nine themes for patient involvement emerged. These themes concerned enablers, activities, and consequences of patient involvement. The themes are synthesized into a tentative model of patient involvement.

Conclusions: Patient involvement can be enabled by factors such as patient education and empowerment, staff training, and organizational systems. Positive effects on costs, satisfaction, and health are indicated as outcomes of patient involvement. Care providers should apply a system perspective on patient involvement in which factors relating to staff, patients, and organizational structures are considered when implementing patient involvement practices.

Keyword
Patient Involvement, participation, health care, patient empowerment, shared decision making
National Category
Engineering and Technology
Identifiers
urn:nbn:se:liu:diva-105926 (URN)
Conference
HELIX Conference, Innovative Practices in Work, Organisation and Regional Development - Problems and Prospects, June 12-14, Linköping, Sweden
Available from: 2014-04-14 Created: 2014-04-14 Last updated: 2014-05-19Bibliographically approved
2. Solicited Diaries as a Means of Involving Patients in Development of Healthcare Services
Open this publication in new window or tab >>Solicited Diaries as a Means of Involving Patients in Development of Healthcare Services
Show others...
2011 (English)In: International Journal of Quality and Service Sciences, ISSN 1756-669X, E-ISSN 1756-6703, Vol. 3, no 2, 128-145 p.Article in journal (Refereed) Published
Abstract [en]

Purpose – The purpose of this paper is to develop an understanding of how patients experience their health problems and how they can generate innovative ideas about health care services. The research questions that guide the present study are: how can solicited diaries be used for capturing patient ideas? What type of data is generated from solicited diaries used for generating patient ideas? And what are the potential benefits and shortcomings of using patient diaries in generating ideas for improvement of health care services?

Design/methodology/approach – The paper is based on an exploratory case study using patient diaries to solicit ideas about how health care services in Sweden can be improved. From the methodological viewpoint, the diaries are used as a tool for patient co-creation of health care services.

Findings – When analyzing dairies written by patients four different types of diaries emerged from the study: brief, reporting, descriptive and reflective diaries. Furthermore, 102 ideas for improvements within nine areas were identified from the contents of dairies.

Research limitations/implications – Adopting patients' diaries as a way to activate and promote co-creation of values is at an embryo stage, and hence more research is needed.

Originality/value – One of the strengths of the paper includes its potential for practical implications, either clinical or methodological, by using patients' dairies. It focuses both on the content generated from the diaries for improving health services, as well as the use of the diaries for practicing the idea of patients as co-creators in health care service.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2011
Keyword
Diaries, Health care, Knowledge transfer, Quality improvement, Sweden, Users' experiences
National Category
Other Engineering and Technologies not elsewhere specified
Identifiers
urn:nbn:se:liu:diva-77457 (URN)10.1108/17566691111146050 (DOI)
Available from: 2012-05-17 Created: 2012-05-17 Last updated: 2017-12-07Bibliographically approved
3. Co-­‐creation and learning in healthcare service development
Open this publication in new window or tab >>Co-­‐creation and learning in healthcare service development
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
Keyword
Co-creation, service development, healthcare, action research
National Category
Engineering and Technology
Identifiers
urn:nbn:se:liu:diva-78716 (URN)10.1108/09564231211248435 (DOI)000308627000003 ()
Available from: 2012-06-19 Created: 2012-06-19 Last updated: 2017-12-07Bibliographically approved
4. The Influence of Disease and Context on Patient Participation in Healthcare Service Development
Open this publication in new window or tab >>The Influence of Disease and Context on Patient Participation in Healthcare Service Development
2013 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: The experience that patients have gained from their own care and disease makes them a potentially valuable resource in healthcare service development. While service developers in other domains frequently involve users, this practice remains uncommon in healthcare. An initial step for increasing patient participation in healthcare service development is to determine which patients to involve and how. This study aims to clarify the various roles a patient may have in healthcare service development and examine how type of disease (episodic/chronic) and context (home/care provider) influence what forms of patient participation are suitable in healthcare service development.

Methods: Fifty-three patients participated in a healthcare service development project in which patients submitted ideas and reflections in diaries. From the diaries, we identified 360 ideas that we coded according to their types, characteristics and sources. We used logistic regression to investigate how the characteristics and sources of the ideas depended on the type of disease and context of the patients.

Results: Patients’ ideas concerned a large variety of topics and depended on context and disease. Patients were better at identifying solutions in the home than at the care provider (p<0.01). In terms of the patient’s role in executing ideas, there were differences regarding context (p<0.01) and an interaction effect between context and type of disease (p<0.01). Chronic patients mostly suggested ideas for themselves. Negative experiences were important to the generation of ideas, with differences regarding both the type of disease (p<0.01) and the context (p<0.01). Chronic patients’ ideas often stemmed from negative incidents; for episodic patients at home, from positive events. There were differences regarding the idea’s appearance for type of disease (p<0.01); for chronic patients ideas emerged from continuous problems, for episodic patients from new situations.

Conclusions: Based on the type of disease (episodic/chronic) and context (home/care provider), we have identified four different roles that a patient can have in healthcare service development: feedback provider, problem solver, co-developer, and expert. We suggest different methods for patient participation in healthcare service development for each role. By doing so, this article helps care provider’s select appropriate methods to support patient participation in healthcare service development.

Keyword
Patient participation; healthcare service development; patient centred care, diaries
National Category
Engineering and Technology
Identifiers
urn:nbn:se:liu:diva-105928 (URN)
Conference
HELIX Conference, Innovative Practices in Work, Organisation and Regional Development - Problems and Prospects, June 12-14, Linköping, Sweden
Available from: 2014-04-14 Created: 2014-04-14 Last updated: 2014-05-19Bibliographically approved
5. Patient involvement in healthcare service development: Who to involve and why
Open this publication in new window or tab >>Patient involvement in healthcare service development: Who to involve and why
2013 (English)Conference paper, Oral presentation only (Other academic)
Abstract [en]

This article explores how the most innovative users can contribute to healthcare service development through cocreation. Despite the widely acknowledged need to innovate and create more user-centered healthcare services, the role of the patient in service development is by tradition passive, and innovation is technology-centered. Drawing on the lead-user methodology, we examine the contributions and behaviors of the most innovative participants in a healthcare service development initiative through patient diaries. With openness, insight, and ingenuity, these patients combine capabilities for innovation with strong relational capabilities to suggest solutions for specific problems. While typical lead users are enthusiasts and lead trends, the examined patients have unmet needs and are often driven by affinity with the care provider and co-patients. We suggest a four-step approach to identifying and involving the most creative and engaged patients.

Keyword
Co-creation, service development, user innovation, healthcare
National Category
Engineering and Technology
Identifiers
urn:nbn:se:liu:diva-105927 (URN)
Conference
The 13th International Research Symposium on Service Excellence in Management, QUIS13 June 10-13, Karlstad, Sweden
Available from: 2014-04-14 Created: 2014-04-14 Last updated: 2014-05-19Bibliographically approved
6. Innovating service while fighting cancer?: User involvement, motivation, and patient well-being
Open this publication in new window or tab >>Innovating service while fighting cancer?: User involvement, motivation, and patient well-being
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Purpose – The purpose of this paper is to examine the motives and experiences service users have to participate in service innovation and how participation effects of the relationship with the caregiver.

Method –Twenty-five patients agreed to participate in the project, in which they were asked to use a diary to record their reflections and ideas for innovations. Fourteen participants completed the task, and we performed additional in-depth interviews with six of these. Using the NVIO software, we applied the theoretical framework to perform a qualitative analysis of the patients’ contributions and the interviews.

Findings – We propose a range of motives from patients being not-interested; believing that participation will give restitution; participating as a form of sociality; feeling an obligation and finally as enjoyment. As patients engaged in the service innovation initiative we also assessed the ways in which involvement may affect quality-of-life. We here use the dimensions of well-being, psychological, physical, existential and support to categorize these influences. The participation seems to have affected two of these dimensions – psychological well-being and support, more than the other two.

Practical implications – We propose that user involvement initiatives should be evaluated not only in terms of the improvements to the service process, but also on the outcomes to the individual user. This study shows that, to the participant, involvement in service innovation is an important event in the context of the relationship with the service provider and is deeply meaning-laden. While service innovation can be a positive and transformative experience, important ethical dilemmas also emerge.

Originality/value – Little research has been conducted into user involvement from a service users’ point of view. This article studies shows the impact user involvement has on the user and the relationship with the service provider.

National Category
Reliability and Maintenance
Identifiers
urn:nbn:se:liu:diva-106659 (URN)
Available from: 2014-05-19 Created: 2014-05-19 Last updated: 2014-05-19Bibliographically approved

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