Value co-creation in health care

A number of articles focusing on value co-creation/value creation in health care services have surfaced within the last five years, highlighting the importance of the interactions and engagement between the health consumer/patient and service provider in this context. However, many studies are still conceptual and invite further testing. Hardyman et al. (2015, p. 92) suggest that the “co-creation of value through engagement in health care

warrants more detailed exploration,” and highlight the need for more empirical analysis and data on this important area in health care services.

Two notable articles on value co-creation in health care include McColl-Kennedy et al’s. (2012) paper on Health care customer value co-creation practice styles and more recently Sweeney et al’s. (2015) paper on Customer effort in value co-creation activities’. McColl- Kennedy et al. (2012) identified five health care customer value practice styles and proposed a heath care customer value co-creation practice styles typology which provides a valuable platform for understanding how health care consumers co-create value with their health care providers. McColl-Kennedy et al. (2012) studied 20 cancer patients in two

private oncology practices and found that “activities” such as collating information and

cerebral activities, “roles” such as assembling and managing a team of health care practitioners, and number of “interactions” with people including family and friends,

contributed to customer value co-creation in this health care setting. The five customer value practice styles that McColl-Kennedy et al. (2012) identified included 1) team management (assembling and managing a health care team), 2) insular controlling (controlling health care from a distance), 3) partnering (collaborating and cooperating with Doctors and other health care professionals), 4) pragmatic adapting (adapting to their changed circumstances) and 5) passive compliance (complying with health care providers). Two styles, team management and partnering, were linked with a higher quality of life for the participants.

A number of studies have identified ‘practice styles’ in mainstream medical health care

(Adams, et al., 2012; Huygen, Mokkink, Smits, Van Son, Meyboom & Van Eyk, 1992; Flocke et al., 2002). In medical literature the emphasis has been on identifying practice styles and determining the correlation between practice styles and satisfaction with care received. Flocke et al. (2002, p. 835) for example concluded that in community based

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medical practices that “the person-focused interaction style” was the “most congruent with

patient reported quality of primary care”. Adams et al. (2012) found a cluster of people

who value positive long-term relationships with their doctor and identifies a group of variables, including good dialogue, choice and shared decision making, which indicated a positive partnership between doctor and patient. What is not clear is which attributes the health care consumer values and what the nature is of their involvement in the interaction. Sweeney et al. (2015) builds on work by McColl-Kennedy et al. (2012) by investigating a

“hierarchy of activities that reflect customer effort in value co-creation activities” (p. 2). Importantly, this study recognises the importance of value co-creation taking place beyond firm-customer service interactions and demonstrated that health care customers involve themselves in activities outside of the clinic environment that ultimately contributes to their health and well-being. Significantly this research found that the more effort a health care customer puts into value co-creation activities, such as compliance, actively sharing information, connecting with others, the more satisfied they are and ultimately the greater quality of life they experience. Sweeney et al. (2015) recommend that health care professionals facilitate and encourage customers to engage in value co-creating activities. Due to the client-centred and empowering nature of CAM health care it is assumed that many CAM consumers involve themselves and put reasonable effort into value co-creation activities. Therefore exploring this aspect within a CAM health service context could provide further insights into this important finding. As Zhao et al. (2015) argues, understanding the drivers of patient value co-creation activities is imperative because without knowing, health care providers cannot “adopt effective programs, policies, and services to encourage value co-creation activities or achieve the meaningful health care benefits that can accrue from such practices” (p. 73).

Nordgren (2009) studied value creation using discourse analysis, based on analysis of authoritative texts within the areas of value creation and service management. Nordgren (2009) concluded that the health care customer is a ‘value creator’ of their own health and

life quality. Value is created throughout the health care experience and the “interaction between the provider and the customer” (p. 124). Nordgren (2009) recommends health care

providers encompass value attributes such as experienced health, quality of life, reduced waiting time and accessibility, trust, information, avoidable suffering and avoidable deaths.

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The interpersonal interaction and process of service co-creation is considered by Gill et al. (2011) as a key component in the delivery of quality health care. On the premise that service value creation is interactional, irrespective of the type of service the client is always a co-creator of value through their participation in the creation of the service (Gill et al., 2011). Knowledge about co-creation in health care services is limited despite concepts such as patient-centred care, patient involvement and patient participation being widely discussed in health care literature (Elg, Engström, Witell, & Poksinska, 2012). Elg

et al. (2012) empirical investigation of 53 patients found that “patients can be active contributors of knowledge and skills in health care service development” (p. 338).

Zainuddin et al. (2011) research on value creation in a well-women’s health service highlighted the need to use an experiential approach to study the concept of value in health care as opposed to an economic approach. Four common components of value, including functional (economic value), social value, emotional value and altruistic value, as espoused by Holbrook (2006a), Sheth et al. (1991) and Sweeney and Soutar (2001) were used as a framework to interpret data from 25 in-depth interviews with women with regard to breast screening. Six themes that represent the four components of value (functional, social, emotional and altruistic) emerged and include: 1) Convenience – representing functional value and relates to practical aspects such as convenient location, service processes (reminder phone calls and letters, accessibility), and useful facilities (parking); 2) Control – representing both functional and emotional value and relating to a sense of control over

one’s health; 3) Peace of mind – an emotional response that reduces negative emotions and promotes positive emotions to achieve relief; 4) Behaviour as reinforcement for beliefs – representing emotional value where existing beliefs about health are reinforced positively; 5) Identification of self as an influencer – representing social value where performing desired behaviours (having a breast screen) potentially influences others into performing and maintaining the same behaviours; 6) Benefit of behaviour to others – representing altruistic value where performing health behaviours are for the benefits of others, e.g.

family and friends. Zainuddin et al. (2011) state that their research “constitutes the first step towards understanding consumers’ value interpretations during the consumption of health services” (p. 370). This study highlights the usefulness of using an ‘experiential approach’ to consumer value as advocated by Holbrook (1994, 1999) in a health care

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A study by Bishop et al. (2010) has begun to highlight the broad nature of CAM as an experience and provides some insight into what consumers may gain from their

consumption experiences. Bishop et al’s. (2010) study found consumers described and

evaluated their CAM experiences along four dimensions: 1) interpersonal - relationship with the practitioner; 2) physical – sensations experienced during or as a result of treatment, e.g. touch or pain; 3) affective – emotional aspects, e.g. feeling empowered, happy, reassured; 4) cognitive – belief about the treatment and gaining new knowledge. Experiences of these dimensions determined whether the consumer would maintain or stop the specific CAM therapy. Interpersonal relationships with the practitioner were found to be a key factor in the maintenance of CAM (Bishop et al., 2010). This finding highlights

the importance of the ‘service’ element of the CAM experience. According to Vos &

Brennan (2010) this is an area within CAM along with consumers’ experiences that

requires more research.