Australasian Marketing Journal

Researchers in services marketing in general, and health services in particular, are increasingly recognising the need for strategies to manage customer variability in the service encounter. The focus of theory and practice to date has been on managing or reducing variability through means such as customer education and tightly controlled service protocols. Growing recognition of the value of co-creation in health care raises the prospect of providers embracing rather than reducing the variability in the service encounter. In this study we investigate how flexibility on the part of service employees can help manage customer variability, and whether this employee flexibility results in favourable outcomes for the patient and the organisation. First, a qualitative study was undertaken to determine the extent of patient variability experienced and how this variability is perceived and managed. Second, a quantitative study, informed by the qualitative phase, was undertaken to test the impact of employee flexibility in a health care service encounter on performance outcomes, namely patient perceived value and patient satisfaction. The results provide support for the conceptual framework, with employee flexibility having a positive relationship with patient satisfaction, partially mediated through the creation of patient perceived value. Managerial and theoretical implications of our findings are discussed.

Health care customers are demanding a more active role in the provision and development of health care services, a position supported by government health care policy in Australia. However, many health care organisations lack an understanding of the capabilities required to respond to this increased participation from customers. This study applies dynamic capability theory through a lens of co-creation to identify organisational capabilities that support customer participation in health care service innovations. A qualitative approach using convergent interviews with health care CEOs and senior managers was undertaken. As a result, four categories of organisational capabilities were identified: customer activation, organisational activation, interaction capabilities, and learning agility. Despite acknowledging the need for these capabilities, most health care organisations perceived they had not developed the required skills and resources. This study provides an insight into the organisational capabilities managers seek to improve their customer participation in health care service innovation.

Governments worldwide face the challenges of an ageing population. New models of health services are being established to support older people to continue living in their homes with timely access to quality health services. Health care provision for older people, however, involves multiple stakeholders, who represent different views on health care, while working towards a common goal. This study presents an action-oriented collaborative process between funders, service providers and clinicians that showcases the development of a client classification (case-mix) system for home-based support service provision in New Zealand. In doing so, this study draws on the concept of boundary objects and develops a unique framework that explicitly showcases the process of aligning diverse stakeholder interests to reach a consensus. This study demonstrates how different manifestations of a single boundary concept-object can effectively bridge all knowledge boundaries and thus develops a new way of using boundary objects for creating effective collaborations.

With the increase in chronic disease and the ageing of the population, understanding requisite self-management adherence of people who are frail is important, especially given its association with service outcomes. This study sought to investigate five key client adherence factors reported in the literature, and frailty reduction in a clinical trial intervention group. The intervention participants in the Frailty Trial were stratified into three groups on the basis of their frailty score; improved, unchanged or deteriorated, and a sample meeting the inclusion criteria was randomly selected from each group. The intervention therapists were asked to complete a survey for each of the clients seeking their views on client motivation, client participation, client–therapist relationship, client trust and the value of the service to the client. A strong relationship was demonstrated between each of the five adherence variables and the outcome of the service, with motivation and participation having the greatest impact.

With the aim of addressing a gap in service research on co-creation in health care, this study discusses the problem of information asymmetry in the service provider–user relationship by adopting the Viable Systems Approach. We develop a three-step interpretative framework to support the understanding of the health service relationship by going beyond the traditional information asymmetry view towards a framework capable of examining the human side of service interaction. Using the case of the Italian Health System, we discuss whether and how the problem of information asymmetry affects the health care provider–user co-creation relationship. Our findings open up a wider view of information asymmetry, suggesting a shift in focus from information sharing to interpretation schemes sharing, all the way up to values sharing, offering new insights for co-creation in health care.

Complementary and Alternative Medicine (CAM) is a fast growing health care service warranting further research to understand its place in modern healthcare. This study investigated what consumers of CAM value from their healthcare experiences. The research adopted an interpretive approach using in-depth interviews with 12 CAM consumers. Seven consumer value components were identified 1) quality of care, 2) treatment efficiency, 3) physical environment, 4) social (esteem) value, 5) spiritual value, 6) ethics (natural aspect), 7) play (relaxation, leisure activities). Findings indicate that CAM consumers evaluate the value of their healthcare experience primarily on quality of care (which revolved around an empowering partnership) and treatment efficiency (such as treatment results and treatment ease of use and customisation) with the physical environment playing a small role. It was through valuing these experiences that the CAM consumer then began to value the other consumer value components – spiritual value, social value, ethics and play. We propose a consumer value model that is relevant to the CAM health care setting, and conclude that the key aspects that CAM consumers value has managerial implications for both CAM and mainstream health providers.

This exploratory work proposes that partnership models of health care provide a context for customer value co-creation as premised within the framework of Service-Dominant Logic (S-D logic). The main objective of this research is to explore the phenomenon of customer value co-creation within a partnership model of health care and classify the nature of activities clients engage in that might be considered customer value co-creation oriented. The context for this study is the New Zealand midwifery service which delivers health care within a partnership model known as the Midwifery Partnership Model (MPM). The study uses a subjective personal introspection (SPI) approach. Reflection and discussion finds a partnership health care model such as the MPM is facilitative of customer value co-creation. However, models predicated only on a partnership practice style may need broadening in order to be more comprehensive of additional potential value co-creation practice styles within a targeted health market. Our study contributes to the field of customer value co-creation in health by addressing calls for more work in the area. In particular this article focuses on a context where partnership is an underlying premise for service design.

Increased longevity means that many people live into their 70s, 80s and beyond, with increasing numbers living with chronic disease. The role of the Internet in the care of chronic disease has been explored within the health literature and, to a lesser extent, within the marketing literature, with recent research suggesting that around 60% of patients source internet-based information about medical conditions and treatment. This mixed-methods study explores the impact of online support groups on the doctor–patient relationship finding that participants in an online support group for inflammatory bowel disease share lay advice, empower each other and act as a credible channel for word-of-mouth referrals. The traditional asymmetric relationship between patient and doctor is challenged by this new form of educated, empowered health consumer who is able to work in partnership with medical service providers in the ongoing management of chronic illness.

Online self-diagnosis, where consumers engage with technology by applying their knowledge and skills to generate a medical diagnosis without the participation of a health care professional, is commonplace. Although co-creation of value for consumers and e-health service providers (i.e., suppliers of technological interfaces for consumers to self-diagnose) can occur via “do-it-yourself” diagnosis, we argue that it also has strong potential for value co-destruction. This is because of deficiencies in or misuse of resources (consumer or e-health provider). Based on a review of the service science, information systems and health care literatures, we develop a typology of value co-destruction in online self-diagnosis. It shows that online self-diagnosis can result in value co-destruction of consumers’ service process and outcome when consumer resources are deficient or misused (e.g., knowledge) or when e-health provider resources are lacking (e.g., poor quality offerings). The value co-destruction perspective has not been examined previously in this context and is important because it can negatively affect consumers’ well-being. A consumer and service focus is missing from research on online self-diagnosis, which our typology addresses. Implications of our typology for providing online health information and more specialised self-diagnosis services are discussed, drawing on a multi-pronged, multi-stakeholder approach, along with future research opportunities.

The growth in demand and expenditure currently being experienced in the Australian health sector is also accompanied by a rise in dysfunctional customer behaviour, such as verbal abuse and physical violence, perpetrated against health service providers. While service failure and poor recovery are known to trigger consumer misbehaviour, this study investigates whether lower than expected perceived service quality generates cognitive and emotional appraisals that trigger two common forms of misbehaviour: refusal to participate and verbal abuse. Data were collected using a 2 × 2 between-subjects experiment administered via online written survey and analysed using path modelling. The findings indicate that perceptions of service encounter quality have an indirect effect on whether consumers refuse to participate in the service and/or verbally abuse the service provider through the mediating effect of anger.

Research aimed at uncovering the motives for the use of dietary supplements among young consumers is of both marketing and public policy importance, and thus deserving of research effort. This research addresses this important health issue from a consumer research perspective, as it is believed that the ultimate responsibility for health maintenance rests with the individual. Drawing on the theory of planned behaviour, this research developed an integrated model to explain dietary supplement consumption, by incorporating a comprehensive set of consumer characteristics. Data were collected using a cross-sectional survey of 438 undergraduate students in Malaysia. Structural equation modelling was used to assess the hypothesised relationships. Findings reveal that health consciousness, health motivation and health value account for significant additional variance, suggesting the particular relevance of these consumer characteristics, in addition to social cognitive factors, in explaining dietary supplement use. This research contributes to marketing theory and practice as well as public health policy formulation.