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  • 1.
    Elg, Mattias
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Engström, Jon
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Witell, Lars
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Poksinska, Bozena
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Co-­‐creation and learning in healthcare service development2012In: Journal of Service Management, ISSN 1757-5818, E-ISSN 1757-5826, Vol. 23, no 3, p. 328-343Article in journal (Refereed)
    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.

  • 2.
    Elg, Mattias
    et al.
    Linköping University, HELIX Vinn Excellence Centre. Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Witell, Lars
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Poksinska, Bozena
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Engström, Jon
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Park Dahlgaard, Su Mi
    Lunds universitet.
    Kammerlind, Peter
    Qulturum, County Council of Jönköping, Sweden.
    Solicited Diaries as a Means of Involving Patients in Development of Healthcare Services2011In: International Journal of Quality and Service Sciences, ISSN 1756-669X, E-ISSN 1756-6703, Vol. 3, no 2, p. 128-145Article in journal (Refereed)
    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.

  • 3.
    Engström, Jon
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Co-creation in Healthcare Service Development: A Diary-based approach2012Licentiate 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.

    List of papers
    1. Quality Management in Health Care: A Literature Review
    Open this publication in new window or tab >>Quality Management in Health Care: A Literature Review
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Purpose – The purpose of this article is to provide input to the discussion of quality management (QM) research in health care through a problematization of its defining characteristics, and to identify historical and contemporary trends regarding QM in the scientific discourse on health care.

    Design/methodology/approach – This article is based on a literature review of leading journal articles concerning quality management in health care. Articles have been selected based on citation in Scopus and ISI/Web of Science, with a total of 36 articles.

    Findings – The review has shown that there are two logics to quality management and improvement work in health care. Dominating the field is an ambition to standardize the provision of health care through an evidence based approach. The other approach is based on a system based logic, aiming to enforce organizational competence and system wide improvement. Unlike the general discourse on quality management is the customer perspective is rather weakly represented in the reviewed literature.

    Research limitations/implications – This article provides some insights that may contribute to a better understanding of the conditions for doing research and improvement in health care.

    Originality/value – The article provides an overview of the defining characteristics of Quality Management in health care, along with a historical perspective on the theoretical development of Quality related topics in health care research. This provides important input to management researchers entering the health care field. To the authors’ knowledge, this is the first review on this topic.

    Keywords
    Quality management, health care, core principles
    National Category
    Engineering and Technology
    Identifiers
    urn:nbn:se:liu:diva-78714 (URN)
    Available from: 2012-06-19 Created: 2012-06-19 Last updated: 2015-02-05Bibliographically 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, p. 128-145Article 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
    Keywords
    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. Patient Ideation in Service Innovation
    Open this publication in new window or tab >>Patient Ideation in Service Innovation
    2011 (English)Conference paper, Published paper (Other academic)
    Abstract [en]

    Customer involvement in the ideation of service innovation is generally considered a means for the service provider to find original ideas, which result in high impact on customer satisfaction. In this study patients record ideas using a diary over a course of two weeks, capturing ideas “in situ” at the hospital or in the home environment. The study shows that patients can provide valuable ideas from the customer perspective and that they often wish to be more active participants.

    National Category
    Engineering and Technology
    Identifiers
    urn:nbn:se:liu:diva-78715 (URN)
    Conference
    QUIS12. The 12th International Research Symposium on Service Excellence in Management, Cornell, NY, USA, June 2-5
    Available from: 2012-06-19 Created: 2012-06-19 Last updated: 2012-06-19Bibliographically approved
    4. 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, p. 328-343Article 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
    Keywords
    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.
    Engström, Jon
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Patient Ideation in Service Innovation2011Conference paper (Other academic)
    Abstract [en]

    Customer involvement in the ideation of service innovation is generally considered a means for the service provider to find original ideas, which result in high impact on customer satisfaction. In this study patients record ideas using a diary over a course of two weeks, capturing ideas “in situ” at the hospital or in the home environment. The study shows that patients can provide valuable ideas from the customer perspective and that they often wish to be more active participants.

  • 5.
    Engström, Jon
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Patient involvement and service innovation in healthcare2014Doctoral 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.

    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.

    Keywords
    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, p. 128-145Article 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
    Keywords
    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, p. 328-343Article 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
    Keywords
    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.

    Keywords
    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.

    Keywords
    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
  • 6.
    Engström, Jon
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Users in service innovation- Inducing creativity2014Conference paper (Other academic)
  • 7.
    Engström, Jon
    et al.
    Linköping University, Department of Management and Engineering, Business Administration. Linköping University, Faculty of Arts and Sciences.
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Logistics & Quality Management. Linköping University, Faculty of Science & Engineering. Linköping University, HELIX Vinn Excellence Centre.
    A self-determination theory perspective on customer participation in service development2015In: Journal of Services Marketing, ISSN 0887-6045, E-ISSN 0887-6045, Vol. 29, no 6/7, p. 511-521Article in journal (Refereed)
    Abstract [en]

    Purpose– The purpose of this paper is to explore what motivates patients to participate in service development and how participation may influence their well-being. Health-care providers are increasingly adopting practices of customer participation in such activities to improve their services.Design/methodology/approach– This paper builds on an analysis of data from a service development project in which lung cancer patients contributed by sharing their ideas and experiences through diaries. Out of the 86 lung cancer patients who were invited to participate, 20 agreed to participate and 14 fully completed the task. The study builds on participants’ contributions, in-depth interviews with six participants and the reasons patients gave for not participating.Findings– This paper identifies a number of motives: non-interest in participating, restitution after poor treatment, desire for contact with others, volunteerism, desire to make a contribution and the enjoyment of having a task to complete. A self-determination theory perspective was adopted to show how the need to satisfy basic human needs for autonomy, competence and relatedness determines if and how patients participate. Participation may have important benefits for patients, especially an improved sense of relatedness.Practical implications– Service providers must be prepared to meet different patient needs in service development, ranging from the need to express strong distress to expressing creativity. By understanding the dynamics of motivation and well-being, organizers may achieve better results in terms of improved services and in patient well-being.Originality/value– This study makes a significant contribution to the study of customer participation in service development, especially in relation to health care, by offering a self-determination-based typology for describing different styles of patient participation.

  • 8.
    Engström, Jon
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Innovating service while fighting cancer?: User involvement, motivation, and patient well-beingManuscript (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.

  • 9.
    Engström, Jon
    et al.
    Linköping University, Department of Management and Engineering, Business Administration. Linköping University, Faculty of Arts and Sciences. Linköping University, HELIX Vinn Excellence Centre.
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Logistics & Quality Management. Linköping University, Faculty of Science & Engineering. Linköping University, HELIX Vinn Excellence Centre.
    Poksinska, Bozena
    Linköping University, Department of Management and Engineering, Logistics & Quality Management. Linköping University, Faculty of Science & Engineering. Linköping University, HELIX Vinn Excellence Centre.
    Witell, Lars
    Linköping University, Department of Management and Engineering, Business Administration. Linköping University, Faculty of Arts and Sciences. Linköping University, HELIX Vinn Excellence Centre.
    Snyder, Hannah
    Linköping University, Department of Management and Engineering, Logistics & Quality Management. Linköping University, Faculty of Science & Engineering.
    The role of customers in the development of public organizations2015In: Sustainable development in organizations: studies on innovative practices / [ed] Mattias Elg, Per-Erik Ellström, Magnus Klofsten, Malin Tillmar, Cheltenham: Edward Elgar Publishing, 2015, p. 93-108Chapter in book (Refereed)
  • 10.
    Engström, Jon
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Langstrand, Jostein
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, HELIX Vinn Excellence Centre. Linköping University, The Institute of Technology.
    Quality Management in Health Care: A Literature ReviewManuscript (preprint) (Other academic)
    Abstract [en]

    Purpose – The purpose of this article is to provide input to the discussion of quality management (QM) research in health care through a problematization of its defining characteristics, and to identify historical and contemporary trends regarding QM in the scientific discourse on health care.

    Design/methodology/approach – This article is based on a literature review of leading journal articles concerning quality management in health care. Articles have been selected based on citation in Scopus and ISI/Web of Science, with a total of 36 articles.

    Findings – The review has shown that there are two logics to quality management and improvement work in health care. Dominating the field is an ambition to standardize the provision of health care through an evidence based approach. The other approach is based on a system based logic, aiming to enforce organizational competence and system wide improvement. Unlike the general discourse on quality management is the customer perspective is rather weakly represented in the reviewed literature.

    Research limitations/implications – This article provides some insights that may contribute to a better understanding of the conditions for doing research and improvement in health care.

    Originality/value – The article provides an overview of the defining characteristics of Quality Management in health care, along with a historical perspective on the theoretical development of Quality related topics in health care research. This provides important input to management researchers entering the health care field. To the authors’ knowledge, this is the first review on this topic.

  • 11.
    Engström, Jon
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Snyder, Hannah
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, HELIX Vinn Excellence Centre. Linköping University, The Institute of Technology.
    Patient involvement in healthcare service development: Who to involve and why2013Conference paper (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.

  • 12.
    Engström, Jon
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Witell, Lars
    Linköping University, Department of Management and Engineering, Business Administration. Linköping University, Faculty of Arts and Sciences.
    Service dominant logic in health care: Making sense of value2014In: Services Marketing in the New Economic and Social Landscape, American Marketing Association, 2014Conference paper (Other academic)
  • 13.
    Engström, Jon
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Witell, Lars
    Linköping University, Department of Management and Engineering, Business Administration. Linköping University, Faculty of Arts and Sciences.
    Poksinska, Bozena
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology. Linköping University, HELIX Vinn Excellence Centre.
    Snyder, Hannah
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    User innovation in health care – the influence of co-creation and context2014In: User innovation in health care – the influence of co-creation and context, American Marketing Association, 2014Conference paper (Other academic)
  • 14.
    Poksinska, Bozena Bonnie
    et al.
    Linköping University, Department of Management and Engineering, Logistics & Quality Management. Linköping University, Faculty of Science & Engineering.
    Fialkowska-Filipek, Malgorzata
    Wroclaw University of Technology, Wroclaw, Poland.
    Engström, Jon
    Linköping University, Department of Management and Engineering, Logistics & Quality Management. Linköping University, Faculty of Science & Engineering.
    Does Lean healthcare improve patient satisfaction?: A mixed-method investigation into primary care2017In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 26, no 2, p. 95-103Article in journal (Refereed)
    Abstract [en]

    Background Lean healthcare is claimed to contribute to improved patient satisfaction, but there is limited evidence to support this notion. This study investigates how primary-care centres working with Lean define and improve value from the patient's perspective, and how the application of Lean healthcare influences patient satisfaction.

    Methods This paper contains two qualitative case studies and a quantitative study based on results from the Swedish National Patient Survey. Through the case studies, we investigated how primary-care organisations realised the principle of defining and improving value from the patient's perspective. In the quantitative study, we compared results from the patient satisfaction survey for 23 primary-care centres working with Lean with a control group of 23 care centres not working with Lean. We also analysed changes in patient satisfaction over time.

    Results Our case studies reveal that Lean healthcare implementations primarily target efficiency and little attention is paid to the patient's perspective. The quantitative study shows no significantly better results in patient satisfaction for primary-care centres working with Lean healthcare compared with those not working with Lean. Further, care centres working with Lean show no significant improvements in patient satisfaction over time.

    Conclusions Lean healthcare implementations seem to have a limited impact on improving patient satisfaction. Care providers need to pay more attention to integrating the patient's perspective in the application of Lean healthcare. Value needs to be defined and value streams need to be improved based on both the knowledge and clinical expertise of care providers, and the preferences and needs of patients.

  • 15.
    Poksinska, Bozena
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Engström, Jon
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Value in Lean Healthcare – a critical appraisal from a service perspective2013Conference paper (Refereed)
  • 16.
    Poksinska, Bozena
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Fialkowska, Malgorzata
    Wroclaw University of Technology, Wroclaw, Poland.
    Engström, Jon
    Linköping University, Department of Management and Engineering, Business Administration. Linköping University, Faculty of Arts and Sciences.
    Does Lean healthcare lead to improvement of patient-perceived quality of care?2014In: Proceedings of the 17th QMOD conference on Quality and Service Sciences ICQSS, Prague, Czech Republic, 2014Conference paper (Refereed)
    Abstract [en]

    Background – Lean healthcare is claimed to contribute to improved patient value, but there is a limited research whether the application of Lean practices leads to improvement of patient perceived quality of care.

    Methods –We used the data from the Swedish National Patient Survey to investigate if there are significant differences in patient-perceived quality of care between primary care units working with Lean and the control group, and if the patient-perceived quality improved over time. Moreover, to gain more in-depth understanding, we have performed two case studies in primary care units and investigate how the case organisations operationalized Lean principles with regards to definition and creation of value.

    Results – The application of Lean healthcare practices doesn’t lead to improvement of patient perceived quality of care. In fact, the patients perceived a deterioration of quality of care in respect to informing them and meeting their needs. Providing timely and efficient care, which means reducing disturbances, waits and delays both for those who receive and those who give care, was an important principle characterizing Lean improvement work at case organisations. Little attention is paid to patient value and involving patients in improvement activities.

    Conclusions –The implementation of Lean production in the guiding principles of service: customer value and value co-creation. Consequently, improvements tend to focus on internal efficiency and have a limited impact on patient experience. An important strategy is therefore to develop systematic approaches to specify patient value that integrate both the knowledge and clinical expertise of caregivers and the patients’ preferences and experiences in the application of Lean in healthcare.

  • 17.
    Poksinska, Bozena
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Witell, Lars
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Engström, Jon
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Snyder, Hannah
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, The Institute of Technology.
    Listening to the voice of the patient: new insights in health care service development2011In: Proceedings QMOD Conference on Quality and Service Sciences 2011 / [ed] Carmen Jaca, Ricardo Mateo, Elizabeth Viles, Javier Santos, 2011Conference paper (Other academic)
    Abstract [en]

    Background and Purpose

    The patient is usually the only one with a full understanding and experience of an entire health care episode, yet this experience and knowledge is seldom used in health care service development. It is not an understatement to say that lip service is often paid to the patient’s view. This paper aims to draw attention to the possibilities of user-driven innovation in the health care sector. The research question that guides the present study is: How can patients participate in health care development, depending on the degree of co-production in care processes?

    Design/methodology/approach – The empirical data was collected through the use of patient diaries. Participants belonged to either one of two categories of care – chronic disease (rehabilitation, gastro) and episodic disease (orthopaedic surgery). The participants were asked to write about everyday situations which were related to their own health care problem and contacts with health care providers, and write down ideas for improvements. In total, 53 diaries have been collected and analysed. The analysis was made through a process where patient ideas were identified and classified by the researchers. Descriptive statistics on the characteristics of the ideas and their relation to service development were then made.

    Findings – Our results show that patients can make varying contributions to the development of health care services, depending on the degree of co-production and the context of idea generation. Based on these two variables we describe four different roles for the contribution of patients to the development of health care services: patient as provider of information (patient with episodic disease at caregiver); patient as an expert (patient with chronic disease at caregiver); patient as co-developer (patient with chronic disease at home); and patient as sole developer (patient with episodic disease at home).

    Research implications –The patient diary opens new, interesting opportunities in the field of patient co-creation. Much more work is needed in this direction.

    Practical implications – We stress that the patient is an under-used resource and listening to the voice of the patient can generate great benefits for health care service development.

  • 18.
    Snyder, Hannah
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, HELIX Vinn Excellence Centre. Linköping University, The Institute of Technology.
    Engström, Jon
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    The Antecedents and Consequences of Patient Involvement: A Systematic Review and Thematic Analysis2013Conference paper (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.

  • 19.
    Snyder, Hannah
    et al.
    Linköping University, Department of Management and Engineering, Logistics & Quality Management. Linköping University, Faculty of Science & Engineering.
    Engström, Jon
    Linköping University, Department of Management and Engineering, Business Administration. Linköping University, Faculty of Science & Engineering.
    The Antecedents, Forms and Consequences of Patient Involvement: A Narrative Review of the literature2016In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 53, p. 351-378Article, review/survey (Refereed)
    Abstract [en]

    Objectives

    Despite the centrality of patient involvement in the policy and rhetoric of health care, the theoretical and empirical basis for patient involvement is lacking at the micro-level of practice. The purpose of this narrative review is to provide an overview and synthesize the current empirical research related to patient involvement at the micro-level of health care.

    Design

    Narrative review

    Data sources: A database search was conducted (in Pubmed, CINAHL, Academic Search Premier, EconLit and PsycINFO) for articles published between 1990 and April 2015 in the field of patient involvement in health care. Out of 4238 references, 214 articles were eligible for this review.

    Review methods We analyzed our sample using thematic analysis.

    Results

    The reviewed articles revealed nine themes for patient involvement, concerning enablers; empowerment, patient education, communication for involvement, staff training, service systems, types; decision making, delivery, development, and consequences of patient involvement. The themes were synthesized into a tentative model that described patient-involvement research.

    Conclusions

    Our narrative review includes a wide variety of empirical studies on patient involvement in decision-making, delivery and development, and provides an integrative perspective suggesting that patient involvement should be viewed not only as isolated activities, but also as a result of educating and preparing patients, staff and systems.

  • 20.
    Ugochukwu, Paschal
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Engström, Jon
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Langstrand, Jostein
    Linköping University, HELIX Vinn Excellence Centre. Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Lean in the supply chain: A literature review2012In: Management and Production Engineering Review, ISSN 2082-1344, Vol. 3, no 4, p. 87-96Article in journal (Refereed)
    Abstract [en]

    “Lean” is a management philosophy that enhances customer value through waste elimination and continuous improvement in a system, by applying lean principles, practices and techniques. The focus on lean implementations and research had been on a single company without extension to the entire supply chain. When the lean concept is implemented across the entire supply chain, however, it is referred to as a lean supply chain. The purpose of this paper is to review literature on lean in the supply chain and identify research trends and issues within the field. The paper involves a comprehensive review of articles on lean in the supply chain using structured content analysis. The reviewed articles were classified based on the basic characteristics and contextual issues of the articles.The researchers in the field agree that the identified benefits of lean in the supply chain, which include reduced cost, improved quality, faster delivery and flexibility, are linked to the implementation of certain lean principles, practices and techniques in the supply chain. Most of the reviewed articles are case studies, and evidence for the benefits of lean in the supply chain is anecdotal. While the empirical work done in the field is encouraging, quantitative studies to substantiate the claims for the efficiency of lean in the supply chain are lacking. In the reviewed articles, the manufacturing sector received much attention, while the service sector received little attention from researchers in the field. It was generally suggested that the supply chain members, suppliers and manufacturers should be considered in the implementation of lean in the supply chain, while the inclusion of distributors and end customers was not discussed in detail in many of the reviewed articles.

  • 21.
    Witell, Lars
    et al.
    Linköping University, Department of Management and Engineering, Business Administration. Linköping University, Faculty of Arts and Sciences.
    Engström, Jon
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, HELIX Vinn Excellence Centre. Linköping University, The Institute of Technology.
    Snyder, Hannah
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, HELIX Vinn Excellence Centre. Linköping University, The Institute of Technology.
    The Influence of Disease and Context on Patient Participation in Healthcare Service Development2013Manuscript (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.

1 - 21 of 21
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