Value Co-Creation of Health Care Services Through Competency Modeling

Introduction

XYZ Hospital, one of the leading university hospitals in Japan, employs more than 1,000 nurses to deliver diversified health services. In order to retain, evaluate and develop nursing resources, we intended to design a shared internal model of competency in order to facilitate value co-creation of care services within the community of institutional care services focusing on relationships between 1) nurses and patients, 2) nurses and nurses, and 3) nurses and other medical and health services professionals. As such, we intended to generate debate and insights within the teams that are concerned about the required competencies for nurses.

Analytical Framework

A human activity system is a model of a notional system containing the activities that people need to undertake in order to pursue a particular purpose (Checkland, 1981; Jackson, 2003). Figure 1 illustrates the analytical framework for this work. The first layer is the institutional community of care services, where value of direct care services is co-created amongst relationships between patients, nurses, and other medical and health services professionals. This layer is influenced significantly by clinical innovation. The health services professionals including nurses are required to adapt to such innovation in clinical settings.

Figure 1.

Analytical framework

The second layer is associated with human resources management, which supports the first layer. In this layer, agents such as the CEO, vice presidents, the nursing director, nursing managers and business managers are involved in designing and executing the human resources management systems. Here, the value co-creation of care services that primarily emerged in the institutional community of care services is named “value co-creation mode one”. The value co-creation emerging at the second layers is labeled as “value co-creation mode two”.

Human Resource Management System

In generic terms, a system is formed by two constituents, i.e., an entity (components or agents) and the relationships therein that form a coherent whole. Accordingly, human resource management systems, by and large, support decisions and activities concerned with planning, recruiting, developing, and selecting people primarily by sharing a mental model or “thoughtful picture” of people with various stake holders including top management, managers, leaders and staff. As shown in Figure 2, such a mental model, which is usually linked with required job performance in a functional organization, is the description of a value system that constitutes people’s competencies, roles and work environments.

Figure 2.

Model of job performance

Therefore, human resource management systems, if they are deliberately designed and installed, not only set the direction of such specific organizational behavior as recruitment, development and selection, but also visualize and share organizational culture and values with the people concerned. When addressing health services in hospitals, service systems management and design has thus far mainly focused on interactions between clinicians and patients that is based on information and decision support systems. In contrast, limited attention has been paid to the human resource management system from a service management perspective.